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Research

Guidance for post-discharge care following acute kidney injury: an appropriateness ratings evaluation

Jung Yin Tsang, Jonathan Murray, Edward Kingdon, Charlie Tomson, Kyle Hallas, Stephen Campbell and Tom Blakeman
BJGP Open 2020; 4 (3): bjgpopen20X101054. DOI: https://doi.org/10.3399/bjgpopen20X101054
Jung Yin Tsang
1 National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care and Health Services Research, Institute of Population Health, University of Manchester, Manchester, UK
2 NIHR Greater Manchester Patient Safety Translational Research Centre (PTSRC), University of Manchester, Manchester, UK
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  • ORCID record for Jung Yin Tsang
  • For correspondence: jungyin.tsang@manchester.ac.uk
Jonathan Murray
3 Renal Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
4 Academic Health Science Network for the North East and North Cumbria (AHSN NENC), Newcastle upon Tyne, UK
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Edward Kingdon
5 Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
6 Kent Surrey Sussex Academic Health Science Network (KSS AHSN), Crawley, UK
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Charlie Tomson
7 Department of Renal Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Kyle Hallas
1 National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care and Health Services Research, Institute of Population Health, University of Manchester, Manchester, UK
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Stephen Campbell
2 NIHR Greater Manchester Patient Safety Translational Research Centre (PTSRC), University of Manchester, Manchester, UK
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Tom Blakeman
1 National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care and Health Services Research, Institute of Population Health, University of Manchester, Manchester, UK
2 NIHR Greater Manchester Patient Safety Translational Research Centre (PTSRC), University of Manchester, Manchester, UK
8 RCGP Clinical Champion for Kidney Care, Royal College of General Practitioners, London, UK
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Abstract

Background Acute kidney injury (AKI) is associated with poor health outcomes, including increased mortality and rehospitalisation. National policy and patient safety drivers have targeted AKI as an example to ensure safer transitions of care.

Aim To establish guidance to promote high-quality transitions of care for adults following episodes of illness complicated by AKI.

Design & setting An appropriateness ratings evaluation was undertaken using the RAND/UCLA Appropriateness Method (RAM). The Royal College of General Practitioners (RCGP) AKI working group developed a range of clinical scenarios to help identify the necessary steps to be taken following discharge of a patient from secondary care into primary care in the UK.

Method A 10-person expert panel was convened to rate 819 clinical scenarios, testing the most appropriate time and action following hospital discharge. Specifically, the scenarios focused on determining the appropriateness and urgency for planning: an initial medication review; monitoring of kidney function; and assessment for albuminuria.

Results Taking no action (that is, no medication review; no kidney monitoring; or no albuminuria testing) was rated inappropriate in all cases. In most scenarios, there was consensus that both the initial medication review and kidney function monitoring should take place within 1–2 weeks or 1 month, depending on clinical context. However, patients with heart failure and poor kidney recovery were rated to require expedited review. There was consensus that assessment for albuminuria should take place at 3 months after discharge following AKI.

Conclusion Systems to support tailored and timely post-AKI discharge care are required, especially in high-risk populations, such as people with heart failure.

  • acute kidney injury
  • heart failure
  • patient discharge
  • primary health care
  • general practice
  • Received February 6, 2020.
  • Accepted February 10, 2020.
  • Copyright © 2020, The Authors

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

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Guidance for post-discharge care following acute kidney injury: an appropriateness ratings evaluation
Jung Yin Tsang, Jonathan Murray, Edward Kingdon, Charlie Tomson, Kyle Hallas, Stephen Campbell, Tom Blakeman
BJGP Open 2020; 4 (3): bjgpopen20X101054. DOI: 10.3399/bjgpopen20X101054

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Guidance for post-discharge care following acute kidney injury: an appropriateness ratings evaluation
Jung Yin Tsang, Jonathan Murray, Edward Kingdon, Charlie Tomson, Kyle Hallas, Stephen Campbell, Tom Blakeman
BJGP Open 2020; 4 (3): bjgpopen20X101054. DOI: 10.3399/bjgpopen20X101054
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Keywords

  • acute kidney injury
  • heart failure
  • patient discharge
  • primary health care
  • General practice

More in this TOC Section

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  • Study of the sensitivity and specificity of smell and taste disorders as a predictive factor of SARS-CoV-2 infection among primary care healthcare professionals: a retrospective observational study
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