The project aimed to gather background data on the incidence of community acquired Acute Kidney Injury (AKI), gather data on the knowledge and confidence of community health care professionals and patients on the topic of AKI, and develop innovative educational resources to try and reduce the severity and incidence of AKI in the community.
This project was delivered by experienced clinicians at University Hospitals of Leicester and Royal Derby Hospital with educational support from the University of Leicester’s Department of Medical and Social Care Education.
The problemAKI is a serious condition associated with poor outcomes including significant morbidity and mortality. The 2011 East Midlands HIEC-funded “Improving Outcomes in AKI” project demonstrated that more than 50% of patients presenting to hospital with AKI develop it in the community.
Fifteen percent of these patients presenting with the most severe form of AKI were previously known to the renal team. Medications that are commonly used to treat hypertension, cardiac problems, proteinuria and some analgesics may be instrumental in causing AKI if continued when patients become acutely well.
The 2009 NCEPOD report ‘Acute Kidney Injury: Adding Insult to Injury’ showed that AKI is not managed well in hospital and recommended improvements in education and training for all healthcare staff. Educating and empowering patients has been shown to improve outcomes in several chronic diseases. The British Renal Association has recommended raising awareness of AKI to try and improve clinical outcomes. However, there is little existing information about the role of educating and empowering patients to reduce the risk of AKI.
Proposed education interventionAn online educational toolkit was developed for primary care professionals. Users are asked to work through realistic clinical case studies, showing how an incidence of AKI might unfold in clinical practice. The toolkit was designed to highlight the common causes of AKI while maximising user engagement and educational value.
Community healthcare professionals were also taught in face-to-face educational sessions, which allowed the project team to assess and increase the knowledge of AKI among this group. A survey was conducted among chronic kidney disease (CKD) patients to assess their knowledge and confidence of medicine management during times of illness. A leaflet was developed to provide information to patients about sick day rules.
Benefit to Patients• CKD patients empowered to understand the risks of AKI
• Information leaflet produced to increase awareness of AKI and teach patients how to avoid developing it
• Expected reduction in number of patients developing AKI, leading to reduced morbidity and mortality rates
Benefits to service• Increased knowledge of AKI among patients and primary care professionals
• eLearning tool to improve clinician understanding of AKI developed
• Greater understanding of knowledge of AKI among patients with CKD
• Baseline data on AKI hospital admission rates from pilot GP practices collected, which will be compared to post-intervention data in mid-2014
• Lessons learnt from project about depth of knowledge will be used to inform future educational interventions
Productivity and impact• 126 primary healthcare professionals educated on AKI in face-to-face sessions
• Patient education leaflets piloted in 10 primary care practices in Derbyshire and Cornwall
• Improved knowledge of AKI among professionals and patients should lead to a reduced burden from the disease and improved care for patients suffering from it
In early 2012, there were around 300 new presentations per month of AKI at Leicester Royal Infirmary. Given that patients with AKI face long hospital stays and intensive treatment, a modest 5% reduction in the incidence of AKI could result in 15 patients avoiding hospitalisation and potential cost savings of over £200,000, per month, at one hospital alone.
Professor Susan Carr
Consultant Nephrologist, University Hospitals of Leicester
Tel: 0116 258 8010
Dr Nick Selby
Consultant Nephrologist, Royal Derby Hospital
Tel: 01332 789344