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Development and Outcomes of an Acute Kidney Injury Outreach Service at a Large University Teaching HospitalBisset L, Van Baalen C, Weston G, Bebb C, Hall M, Ferraro A, Porter C, Juurlink I, Devonald MNottingham Renal & Transplant Unit, City Campus, Nottingham University Hospitals NHS Trust, Nottingham, UKBackgroundAcute kidney injury (AKI) is common and harmful but also treatable and avoidable. Approximately 1 in 10 people admitted as an emergency will experience some degree of AKI. All stages of AKI are associated with prolonged lengths of stay (and associated costs), increased morbidity and mortality and carry a risk of developing chronic kidney diseaseBeing one of the largest NHS trusts in the United Kingdom. It provides services for 2.5 million residents, with a total of 1700 inpatient beds on two campuses situated approximately 3 miles apart. However, until recently nephrology services were base at only one of the campuses and all acute admissions (and the majority of AKI) were admitted to the campus with no nephrology input. Prior to introduction of the AKI service the majority of advice on AKI were telephone consultations.AKI ‘outreach’ ServiceIn October 2013 an 18 month pilot project began to deliver an AKI service at the campus with no ‘on-site’ nephrologist. The service consists of a renal consultant and 2 specialist nurses. Patients with AKI stage 2 & 3 are identified from a list automatically generated from the AKI alert system within the hospital results system. The service seeks to respond to all in-patients (including patients admitted to ED) generating an AKI e-alert for clinical assessment. The team also provides an educational programme to medical and nursing staff and have contributed to trust wide developments to improve the care of patients with AKI.ResultsSince introduction of the service over an 8-month period (Nov 13-Jul 14) over 4210 AKI alerts have been screened. The team have assessed 1490 new patients, discussed 411 patients and followed-up 727 patients with AKI. An additional 495 non-AKI patients have been assessed. Data is currently available on 866 patients. Mean age 75 and 46% male. 58% patients had stage 2, 30% stage 3 and 12% stage 1 AKI. 24% patients developed hospital acquired AKI. 79% patients were seen within 24hrs of the generation of the AKI e-alert. Advice on fluid management, medications was 80% and 30% respectively. 77% survived. Of the 23% patients who died, 40% AKI fully or partially recovered. Comparing pre and post outreach service for the first 7 months. Average length of stay has reduced from 15.9 to 12.8 days for stage 2 AKI and from 15.5 to 13.1 for stage 3 AKI. Readmission rates for AKI stages 2 and 3 reduced from 16 to 12%. Mortality from AKI and renal replacement therapy rates were unchanged. HRG coding for AKI has also improved.ConclusionsThe AKI ‘outreach’ services aims to improve the management and outcomes of patients with AKI through early identification, assessment and intervention. Although mortality and RRT remains unchanged this reflects the complex nature of AKI. The team act as a ‘safety net’ for patients with AKI and have raised the profile of AKI not only in terms of management but also in AKI risk assessment and prevention. The benefits of the team have been recognised and resulted in the acquisition of permanent funding for the AKI service. ................
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