Abstract
Acute Kidney Injury (AKI), an abrupt deterioration in kidney function, is defined by changes in urine output or serum creatinine. AKI is common (affecting up to 20% of acute hospital admissions in the United Kingdom), associated with significant morbidity and mortality, and expensive (excess costs to the National Health Service in England alone may exceed £1 billion per year). NHS England has mandated the implementation of an automated algorithm to detect AKI based on changes in serum creatinine, and to alert clinicians. It is uncertain, however, whether 'alerting' alone improves care quality. We have thus developed a digitally-enabled care pathway as a clinical service to inpatients in the Royal Free Hospital (RFH), a large London hospital. This pathway incorporates a mobile software application - the "Streams-AKI" app, developed by DeepMind Health - that applies the NHS AKI algorithm to routinely collected serum creatinine data in hospital inpatients. Streams-AKI alerts clinicians to potential AKI cases, furnishing them with a trend view of kidney function alongside other relevant data, in real-time, on a mobile device. A clinical response team comprising nephrologists and critical care nurses responds to these AKI alerts by reviewing individual patients and administering interventions according to existing clinical practice guidelines. We propose a mixed methods service evaluation of the implementation of this care pathway. This evaluation will assess how the care pathway meets the health and care needs of service users (RFH inpatients), in terms of clinical outcome, processes of care, and NHS costs. It will also seek to assess acceptance of the pathway by members of the response team and wider hospital community. All analyses will be undertaken by the service evaluation team from UCL (Department of Applied Health Research) and St George's, University of London (Population Health Research Institute).
Highlights
Acute kidney injury (AKI) is a sudden loss of kidney function, defined by a rise in serum creatinine or a fall in urine volume[1]
On the basis that the prompt and reliable identification of AKI cases to clinicians may trigger improved care, National Health Service (NHS) England issued a national patient safety alert on “standardising the early identification of Acute Kidney Injury”[12]. This mandated the installation of a new detection algorithm in each NHS hospital, so that potential AKI incidents could be flagged to treating clinicians
We propose a service evaluation of the introduction of the digitally-enabled care pathway with respect to processes of care, patient outcomes, qualitative feedback from patients and staff, and NHS costs
Summary
Acute kidney injury (AKI) is a sudden loss of kidney function, defined by a rise in serum creatinine or a fall in urine volume[1]. On the basis that the prompt and reliable identification of AKI cases to clinicians may trigger improved care, NHS England issued a national patient safety alert on “standardising the early identification of Acute Kidney Injury”[12]. This mandated the installation of a new detection algorithm in each NHS hospital, so that potential AKI incidents could be flagged to treating clinicians. The application will provide real-time alerts of potential AKI cases, alongside other critical clinical data, to a clinical response team comprising nephrologists and critical care nurses This response team will assess the data provided by the application, prioritise cases and deliver investigations and therapies according to current best practice guidelines[11]. The evaluation will assess the experience of service users (RFH in-patients who have been treated by the pathway), members of the clinical response team and the wider clinical community of RFH
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