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Service evaluation of the implementation of a digitally-enabled care pathway for the recognition and management of acute kidney injury (version 2)

Connell, A; Montgomery, H; Morris, S; Nightingale, C; Stanley, S; Emerson, M; Jones, G; ... Laing, C; + view all (2017) Service evaluation of the implementation of a digitally-enabled care pathway for the recognition and management of acute kidney injury (version 2). F1000Res , 6 , Article 1033. 10.12688/f1000research.11637.2. Green open access

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Abstract

Acute Kidney Injury (AKI), an abrupt deterioration in kidney function, is defined by changes in urine output or serum creatinine. AKI is common (affecting up to 20% of acute hospital admissions in the United Kingdom), associated with significant morbidity and mortality, and expensive (excess costs to the National Health Service in England alone may exceed £1 billion per year). NHS England has mandated the implementation of an automated algorithm to detect AKI based on changes in serum creatinine, and to alert clinicians. It is uncertain, however, whether 'alerting' alone improves care quality. We have thus developed a digitally-enabled care pathway as a clinical service to inpatients in the Royal Free Hospital (RFH), a large London hospital. This pathway incorporates a mobile software application - the "Streams-AKI" app, developed by DeepMind Health - that applies the NHS AKI algorithm to routinely collected serum creatinine data in hospital inpatients. Streams-AKI alerts clinicians to potential AKI cases, furnishing them with a trend view of kidney function alongside other relevant data, in real-time, on a mobile device. A clinical response team comprising nephrologists and critical care nurses responds to these AKI alerts by reviewing individual patients and administering interventions according to existing clinical practice guidelines. We propose a mixed methods service evaluation of the implementation of this care pathway. This evaluation will assess how the care pathway meets the health and care needs of service users (RFH inpatients), in terms of clinical outcome, processes of care, and NHS costs. It will also seek to assess acceptance of the pathway by members of the response team and wider hospital community. All analyses will be undertaken by the service evaluation team from UCL (Department of Applied Health Research) and St George's, University of London (Population Health Research Institute).

Type: Article
Title: Service evaluation of the implementation of a digitally-enabled care pathway for the recognition and management of acute kidney injury (version 2)
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.12688/f1000research.11637.2
Publisher version: http://dx.doi.org/10.12688/f1000research.11637.2
Language: English
Additional information: Copyright © 2017 Connell A et al. This is an open access article distributed under the terms of the Creative Commons Attribution Licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: AKI, acute kidney injury, e-alert, nephrology
UCL classification: UCL > School of Life and Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Life Sciences
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > Medicine (Division of) > Internal Medicine
UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health Care
UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health Care > Applied Health Research
URI: http://discovery.ucl.ac.uk/id/eprint/10041426
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