E-Thesis 117 views 49 downloads
Acute Kidney Injury in Wales / Timothy Scale
Swansea University Author: Timothy Scale
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DOI (Published version): 10.23889/SUthesis.65412
Abstract
BackgroundAcute kidney injury (AKI) is a common condition with poor outcomes. Deficiencies in care are well described, so clinician-facing electronic AKI alerts (eAlert) were attached to blood test results in Wales with the aims of improving recognition and clinical outcomes.AimsCreate an AKI cohort...
| Published: |
Swansea, Wales, UK
2023
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| Institution: | Swansea University |
| Degree level: | Doctoral |
| Degree name: | M.D |
| Supervisor: | Lyons, Ronan A; Bain, Steve C; Chess, James A |
| URI: | https://cronfa.swan.ac.uk/Record/cronfa65412 |
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| Abstract: |
BackgroundAcute kidney injury (AKI) is a common condition with poor outcomes. Deficiencies in care are well described, so clinician-facing electronic AKI alerts (eAlert) were attached to blood test results in Wales with the aims of improving recognition and clinical outcomes.AimsCreate an AKI cohort through replicating eAlerts in the secure anonymised information linkage databank (SAIL), allowing for the validation of the eAlerts sent in practice. Assess the effect of eAlerts on hospital coding, recovery from AKI, need for dialysis, mortality and changes in primary care prescriptions and reviews.MethodAn AKI cohort was created within SAIL by recreating the NHS England eAlert algorithm. Using our renal dataset, we identified patients undergoing dialysis who do not have AKI. Using this cohort as a comparator, we validated the Welsh eAlerts seen in clinical practice, and assessed their effect on mortality, recovery, hospital coding, need for dialysis and primary care Read code entries.ResultsOnly two thirds of AKI recognised by our methodology had an eAlert sent. This is because Welsh eAlerts had a modification applied to it, making it different to the eAlerts used elsewhere in the UK, which was previously unknown to researchers and clinicians. 1 in 12 eAlerts seen by clinicians were false positives (dialysis patients). eAlerts improve recovery from AKI but do not improve the need for dialysis, primary care medication reviews and, in all bar one health board, they do not reduce mortality at 30-days or 1-year. We did not observe an increase in primary care medication reviews, nor did we see changes in many important medication prescriptions following the introduction of eAlerts. ConclusionsWelsh eAlerts alone are not enough to improve AKI outcomes in Wales and standardising alerts with those sent throughout the rest of the United Kingdom is now being adopted. |
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| Item Description: |
Part of this thesis has been redacted to protect personal information |
| Keywords: |
Acute Renal Failure, Acute Kidney Injury, electronic Acute kidney injury alerts, eAlerts, AKI, ARF |
| College: |
Faculty of Medicine, Health and Life Sciences |