I am raising this because of the issues we are seeing , and I'm sure others are too, on a daily basis.
We are starting to get grumblings from Primary and Secondary Care about unnecessary warnings like the following:
92 year old lady, has had pretty stable renal function for last 4 years, CKD stage 3a, latest sample more than 365 days after previous one, with similar value, so now flagged with ? AKI ?CKD please review. GP not amused.
Another scenario, frail elderly patient with anaemia, latest creatinine 35 umol/L, but 5 days ago, after blood transfusion and saline creatinine, dipped to 23 umol/L, so now flagged as AKI Stage 1! All previous creatinine values around 30 umol/L.
And then there is the other end, where probable AKI may be missed.
Patient, current creatinine 160 umol/L, none in last 7 days, but median over last 5 months is 104umol/L, which would suggest AKI Stage 1. BUT, 6 months ago, patient had an episode of AKI ( went from 90 up to 260umol/L), and including these and a further episode of raised creatinine, the 12 month median value is 124umol/L, so latest result is not flagged, so will probably deteriorate again until level rises to over 186umol/L.
I realise this was always going to be a difficult thing to put in place, but there must be a mechanism for review and possible amendment, otherwise, as GP from case one has said, they will just start ignoring them.

Gary Mascall
Consultant Clinical Scientist
Worcestershire Acute Hospitals NHS Trust.