Anonymous summary of responses to AKI flags for primary care split into timing and consequence
Thanks once again everyone who responded.
BW John
Timing
Did is about 11 months ago, three weeks after turning on for trust.
We had not planned to go live with primary care in April - but if the consensus is then we will.
We went live on 1st Feb.
We went live about 6 months ago. No extra resources
We haven't turned on AKI for GPs yet. In discussions with Renal Physician over an appropriate time.
Yes live since April last year. Web page for advice http://heftpathology.com/aki
Consequence
...
* We have had the AKI flags turned on for primary care since April last year, we add an automatically generated comment to all 1, 2 and 3 flags with instructions to discuss the patient with the medical registrar (giving relevant bleep numbers) for stage 2 and to refer the patient to the medical registrar for all stage 3. For stage 1 there is guidance to repeat and what to consider. We also phone all stage 3 (all urgent so sometimes to the out of hours GP service) and all stage 2 but we do leave these until routine hours unless it is a weekend/bank holiday.
* D & B went live for reporting to primary care on 1/10/15. Prior to that we had only been reporting AKI3 alerts for primary care (Which includes our multiple prisons and secure mental health establishments) and phoning them to the requesting doctor or out-of hours service.
* Effects in primary care were not the disaster widely talked about (amongst GPs). Few problems with stage 1 alerts due to heavy intake of standard English breakfast but apart from that there were no problems
* The lab had no resources to provide for secondary care - i.e. we simply supply the flag with the result - so there will be no resource put into primary care when we turn it ON
* It hasn't turned out to be too onerous on the department and we did some GP training sessions before we went live, it seemed less stressful than when eGFR went live many years ago! We do have an AKI enhancing quality team in the Hospital lead by a medical Consultant so we have their support and that has been very useful.
* In theory all GPs attended one of the training sessions delivered by a renal consultant. These were delivered before we turned on the more frequent levels of alert.
* Our text comments point the clinicians towards the treatment guidelines written by the renal consultants.
* There is a primary care version of the guidelines available on both of our CCGs' intranets as well as via the hospital site.
* For those GPs who use the ICE order communications system there are alerts on the system (coloured headers & an icon for the current AKI alert level Red for AKI3, Orange for AKI2, yellow for AKI1. These time out after 3 days .) and there is also a permanent pink alert applied if an individual has had any level of AKI alert since we started the data feed.
* Primary care clinicians already had 24/7 access to the nephrologists before the implementation of AKI alerts on the systems.
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