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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...

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Published: Swansea, Wales, UK 2023
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
first_indexed 2024-01-05T12:21:46Z
last_indexed 2024-11-25T14:16:01Z
id cronfa65412
recordtype RisThesis
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spelling 2024-01-05T12:28:56.2558281 v2 65412 2024-01-05 Acute Kidney Injury in Wales 8166c97315a1cbb44f422e7b2ce69505 Timothy Scale Timothy Scale true false 2024-01-05 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. E-Thesis Swansea, Wales, UK Acute Renal Failure, Acute Kidney Injury, electronic Acute kidney injury alerts, eAlerts, AKI, ARF 4 12 2023 2023-12-04 10.23889/SUthesis.65412 Part of this thesis has been redacted to protect personal information COLLEGE NANME COLLEGE CODE Swansea University Lyons, Ronan A; Bain, Steve C; Chess, James A Doctoral M.D Welsh Kidney Research Unit 2024-01-05T12:28:56.2558281 2024-01-05T12:07:10.1370724 Faculty of Medicine, Health and Life Sciences Timothy Scale 1 65412__29388__a2d02bc6dd7f4cf1968bcc599525104d.pdf 2023_Scale_T.final.65412.pdf 2024-01-05T12:19:11.3811438 Output 14814324 application/pdf E-Thesis – open access true Distributed under the terms of a Creative Commons Attribution 4.0 License (CC BY 4.0). true eng
title Acute Kidney Injury in Wales
spellingShingle Acute Kidney Injury in Wales
Timothy Scale
title_short Acute Kidney Injury in Wales
title_full Acute Kidney Injury in Wales
title_fullStr Acute Kidney Injury in Wales
title_full_unstemmed Acute Kidney Injury in Wales
title_sort Acute Kidney Injury in Wales
author_id_str_mv 8166c97315a1cbb44f422e7b2ce69505
author_id_fullname_str_mv 8166c97315a1cbb44f422e7b2ce69505_***_Timothy Scale
author Timothy Scale
author2 Timothy Scale
format E-Thesis
publishDate 2023
institution Swansea University
doi_str_mv 10.23889/SUthesis.65412
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
document_store_str 1
active_str 0
description 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.
published_date 2023-12-04T20:40:48Z
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score 11.047609

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