Clare
Clare Holdcroft
Biomedical Scientist
Clinical Chemistry Department
Queens Hospital Burton on Trent
-----Original Message-----
From: ACB AKI-Detection-Algorithm
[mailto:[log in to unmask]] On Behalf Of Hill Robert
(NORTH BRISTOL NHS TRUST)
Sent: 17 December 2014 14:01
To: [log in to unmask]
Subject: AKI alerts NI and AKI Incidence
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Interesting thread on AKI incidence from Northern Ireland. NI is not
covered by the AKI programme but is developing a parallel less formal
programme of its own.
Copied with permission
Dr Robert Hill
Consultant Clinical Biochemist
________________________________________
From: Lewington Andrew (LEEDS TEACHING HOSPITALS NHS TRUST)
Sent: 17 December 2014 09:56
To: Morgan, Neal; Hill Robert (NORTH BRISTOL NHS TRUST); Selby Nick
(DERBY HOSPITALS NHS FOUNDATION TRUST)
Cc: Magee, Brian; Harty, John
Subject: RE: AKI alerts NI
Thanks Neal
I meant in terms of capture
Be interested to hear more
BW
Andy
Dr Andy Lewington BSc MEd MD FRCP FRCPE
Consultant Renal Physician/Honorary Clinical Associate Professor
Director of Undergraduate Medical Education LTHT Renal Department St.
James's University Hospital Beckett Street Leeds
LS9 7TF
[log in to unmask]
01132064354
________________________________________
From: Morgan, Neal [[log in to unmask]]
Sent: 16 December 2014 20:09
To: Lewington Andrew (LEEDS TEACHING HOSPITALS NHS TRUST); Hill Robert
(NORTH BRISTOL NHS TRUST); Selby Nick (DERBY HOSPITALS NHS FOUNDATION
TRUST)
Cc: Magee, Brian; Harty, John
Subject: RE: AKI alerts NI
Hi Andy
Do you mean in terms of data capture or longer term follow up?
Data capture
They will be detected on the reverse MDRD 75mls/min part of the
algorithm
Follow up
Any cases we get referred in the trust are put into an excel data sheet,
this is reviewed monthly to track extent of recovery and gauge the most
suitable follow up (GP, nephrology). We are missing all the AKI that
doesn't get referred to renal, hopefully through the eAlert we will be
able to fashion a report to mine down into these cases to ensure they
are followed up and future AKI risk communicated (will need to develop
automated systems to cover this). When the alert goes live on the NI
electronic care record system (this is a global system across primary
and secondary care) we will have the ability to communicate more
directly with primary care colleagues. I had mentioned project ECHO to
Nick as a means to engage primary care and have discussed with our NI
project manager today, renal will be on the pilot of this system and
I'll let you know how it goes. ECHO looks to have the potential to help
alot with AKI and CKD, empowering and generating primary care networks
with lead GPs with a specialist interest in these areas and
nephrologists providing specialist support and facilitating case
discussion.
Best wishes for 2015 and happy christmas Neal
-----Original Message-----
From: Lewington Andrew (LEEDS TEACHING HOSPITALS NHS TRUST)
[mailto:[log in to unmask]]
Sent: 16 December 2014 18:01
To: Hill Robert (NORTH BRISTOL NHS TRUST); Selby Nick (DERBY HOSPITALS
NHS FOUNDATION TRUST); Morgan, Neal
Cc: Magee, Brian; Harty, John
Subject: RE: AKI alerts NI
Hi
Very interesting
How do you deal with patients admitted to the hospital with an elevated
Cr but no baseline whose cr subsequently falls i.e. they had c-AKI?
BW
Andy
Dr Andy Lewington BSc MEd MD FRCP FRCPE
Consultant Renal Physician/Honorary Clinical Associate Professor
Director of Undergraduate Medical Education LTHT Renal Department St.
James's University Hospital Beckett Street Leeds
LS9 7TF
[log in to unmask]
01132064354
-----Original Message-----
From: Hill Robert (NORTH BRISTOL NHS TRUST)
[mailto:[log in to unmask]]
Sent: 16 December 2014 17:53
To: Lewington Andrew (LEEDS TEACHING HOSPITALS NHS TRUST); Selby Nick
(DERBY HOSPITALS NHS FOUNDATION TRUST); Neal Morgan
Cc: Brian Magee; John Harty
Subject: RE: AKI alerts NI
Hi Neal and Nick. It would be really useful to post this discussion on
the ACB-AKI-ALGORITHM JISCMAIL list.
Would either of you object?
Best wishes,
Robert
Dr Robert Hill
Consultant Clinical Biochemist
________________________________________
From: Morgan, Neal [[log in to unmask]]
Sent: 16 December 2014 12:40
To: Selby Nick (DERBY HOSPITALS NHS FOUNDATION TRUST);
[log in to unmask]; Hill Robert (NORTH BRISTOL NHS TRUST)
Cc: Harty, John; Magee, Brian
Subject: RE: AKI alerts NI
Many thanks Nick most useful.
These were just acute inpatients to my knowledge and the reverse MDRD
would have been applied in those without baseline data.
We'll run and internal validation and I'll keep you posted if we pick
anything interesting up (Brian could we dicuss).
Neal
PS Happy Christmas and best wishes for 2015
From: Selby Nick (DERBY HOSPITALS NHS FOUNDATION TRUST)
[mailto:[log in to unmask]]
Sent: 16 December 2014 09:44
To: Morgan, Neal; [log in to unmask]; Hill Robert (NORTH
BRISTOL NHS TRUST)
Cc: Harty, John
Subject: RE: AKI alerts NI
Hi Neal
The incidence of 5% is on the lower end of the published range, but
similar to rates we see with our current alert system in Derby (and that
we have published).
There are a couple of points that are worth thinking about though: have
you included those patients without previous baseline (i.e. those
flagged high creatinine ?CKD ?AKI) - in published data these patients
are usually included using a reverse MDRD calculation to give an
estimated baseline value. Without these patients (which are deliberately
classified separately in the NHSE algorithm) AKI numbers may be 10-20%
lower than most published series.
The second question is to what you have used as the denominator - again,
many published series use admitted patients, excluding day cases etc. so
this may also have an effect.
However, I guess the question is whether there are many flase negative
results - have you had the sense that there are patients with AKI who
are not being picked up? I can't think of a good way of unpicking this
other that to audit some of the patients who weren't flagged as AKI to
determine the false negative rate. We are planning to run our original
detection system and the new NHSE algorithm side by side for a time so
we can look at it this way too.
I've copied Robert Hill into my reply, as co-chair of the Detection
workstream as I'm sure he will be interested in your experience so far.
BW
Nick
Dr Nick Selby
Consultant Nephrologist
Royal Derby Hospital
Uttoxeter Road
Derby
DE22 3NE
Tel: 01332 340131 x89344
________________________________
From: Morgan, Neal [[log in to unmask]]
Sent: 15 December 2014 08:24
To: Selby Nick (DERBY HOSPITALS NHS FOUNDATION TRUST);
[log in to unmask]
Cc: Harty, John
Subject: FW: AKI alerts NI
Hi Nick, Andy
This is the early data on our ECB AKI eAlert. The incidence of 5% is
strikingly low, to get a contemporaneous benchmark I wondered what your
experiences have been?
My colleagues looked at me with a sense of disbelief when presented last
week at our regional forum! We have a risk assessment embedded in the
med admission pack, I argued the newer algorithm would be more effective
at mitigating historic false positives due to CKD. We're going to meet
up with our head of labs to review the data in more detail but it would
be useful to have a heads up on early UK data.
Help much appreciated
Neal
Dr Neal A. Morgan FRCP PhD
Consultant Nephrologist, SHSCT
Honorary Lecturer in Medicine, QUB
From: Magee, Brian
Sent: 04 December 2014 10:37
To: Morgan, Neal; Harty, John
Cc: Carroll, Ronan; McKillop, Derek; Duffin, Kevan; Quinn, Nigel;
ONeill, Paul; Bannon, Chris; Magill, Stephen; Coffey, Wilma; McIlwaine,
Ardelle
Subject: AKI alerts
Dear All
Some high level stats on the AKI alert since its introduction in June.
Brian
Mr Brian Magee
Head of Laboratory Services
SHSCT
028 38612450
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