Acute kidney injury; improving the communication from secondary to primary care

Acute kidney injury (AKI) is a common but preventable event in secondary care. It is known to be associated with poorer outcomes for the patient's future health. Patients therefore require specific after-care in the community following an AKI, both in the short and long term. However, information about an inpatient AKI is often not communicated to primary care at discharge. Only 11.0% of discharge summaries contained full information about an AKI (including stage of AKI, changes to medications and follow-up required) in August 2015. We aimed to improve communication about AKI on discharge summaries via implementation of a series of interventions between June 2015 and March 2016. A specific section was added to the discharge summary software to prompt inclusion of information regarding AKI. An automatic warning message was added later as an additional prompt. A programme of education was provided for the junior doctors. A ward-based campaign was rolled out using the animated character ‘Ned the Nephron,’ using posters, emails and screen savers. We also introduced an AKI warning sticker for drug charts, which reminds the discharging doctor that the patient has had an AKI during the admission. Our primary outcome was the percentage of discharge summaries that had the AKI section completed, as this contained all the desired information, including stage of AKI and frequency of follow up blood tests in primary care. Monthly data collections showed that this gradually increased from 4.7% in September 2015 to 35.0% in January 2016. We expect further increases with the recent introduction of the drug chart sticker.