Since reporting AKI warnings using the WinPath interpretation of the national algorithm, we have seen large numbers of samples (approx 85% of the number of AKI warnings 1 to 3) where the creatinine is above the relevant upper reference limit but with no creatinine in the previous 12 months.
So this is reported as per national algorithm as ?AKI ?CKD suggest repeat.
It is creating a problem for Primary Care clinicians who rightly tell us the patient isn't on annual/regular monitoring, but has always had creatinine of a similar level, and waves are starting to be created.

I realise the algorithm was initially for secondary care, but as we already had something in place for primary care we decided to go "big bang" and introduce it across all clinical areas. So, this may be a problem others only reporting on secondary care patients have not yet encountered, but it is something you do need to be aware of.

Possibly when the algorithm is reviewed this issue might be addressed? I can envisage a few ways to improve things, but as these are outside of the algorithm, and something we have no control of the software to change, this really does need some thought and consideration.

Gary Mascall
Worcestershire Acute Hospitals NHS Trust.