As many as 100,000 deaths in secondary care are associated with AKI each year, according to NHS England. Many more patients go on to endure prolonged hospital admissions and to suffer from secondary chronic conditions.
AKI is often caused by stress on the kidneys due to other illnesses or infection, or the side effects of some drugs. More than a third of AKI cases occur after admission to hospital, with the elderly especially at risk.
However, AKI is often preventable. National reports indicate that the care of up to 40 per cent of patients with AKI is inadequate, partly due to delayed recognition of the problem and that as many as 20 per cent of post-admission AKI incidents are both predictable and avoidable.
Working with clinical input from WSHFT, Alcidion has developed a successful clinical and technology solution with Patientrack, to systematically identify and flag those developing, or those with, AKI, and subsequently promote a swift clinical response that until now has often been lacking.
Patientrack’s early warning system has been used widely at WSHFT in the past to capture bedside observations digitally, automatically calculate National Early Warning Scores (NEWS) and alert clinicians to deteriorating patients who require immediate medical intervention.
The Trust worked with Alcidion to embed a ground-breaking predictive scoring model, developed by its own specialist renal clinicians, into the early warning software platform. This allows an AKI risk score to trigger real-time alerts to medical staff and advise on a best practice checklist that they must follow to care for patients appropriately and prevent conditions worsening.
The model, which is also combined with a national AKI staging algorithm, brings together various sources of data, including pathology results, to assess a patient’s creatinine level and information including a patient’s age, medical history and known co-morbidities, along with physiological information that is recorded at the bedside through Patientrack.
These elements combine to generate a score which is then displayed on the patient’s electronic chart and the hospital’s Patientrack alerting system. Patients identified with AKI are assigned a red flag so that appropriate care can be given immediately. Those at risk of developing AKI are marked with an amber flag so that care packages can be delivered and patients who do not have the condition and are not judged to be at high risk are marked with a green flag.
The solution won national funding from the Department of Health and the Small Business Research Initiative (SBRI) so that it could be trialled at WSHFT, and won a second round of funding with the aim of scaling the AKI alerting technology more widely across the NHS.
The result is an intelligent real-time technology solution designed to systemically improve the care of patients with or at risk of AKI. For the first time, clinicians can have complete visibility of the AKI status of every patient in the hospital. The system allows healthcare professionals to see every identifiable AKI, improve the management of people with AKI, and prevent the preventable.
“Patientrack gives clinicians the ability to flag which patients are at risk of acute kidney injury almost from the moment they walk through the door, so that they can see which patients are at risk from the first set of observations. Effectively it is an intelligent real-time technology that should systemically improve the care of patients. It will prevent and it will help to improve the management of people who come in with AKI.”
– Professor Lui Forni, Consultant in Intensive Care and Renal Medicine and Chair of the AKI Section of the European Society of Intensive Care Medicine
Early intervention should help enable the prevention of morbidity and mortality associated with AKI, including secondary complications such as chronic kidney disease and additional benefits are expected. Reduced lengths of stay, for example, will help to reduce further potential exposure to harm in the hospital environment and the technology could reduce the need for renal replacement therapies and escalation to intensive care.
Financial benefits for hospitals are also realised, and not only as a result of reduced lengths of stay. The solution helps to achieve commissioning for quality and innovation (CQUIN) targets around AKI, an incentive to reward good care of patients with the condition, which contribute to payments worth up to 2.5 per cent of a provider’s annual contract value.
Ultimately, the project is providing doctors and nurses with a more intelligent picture and a rapid, accurate assimilation of various sources of data in order to immediately highlight which patients need intervention to prevent the serious consequences of AKI.
The solution will be developed as time goes on, feeding in new data, such as pharmacy and medication information.
“This technology should be of significant interest to NHS hospitals. Early intervention should help to prevent morbidity and mortality, including secondary complications such as chronic kidney disease. Even more can be achieved, including reduced lengths of stay and the potential for a reduction in renal replacement therapies and escalation to intensive care.”
– Dr Richard Venn, Consultant in Anaesthesia and Intensive Care at Western Sussex Hospitals NHS Foundation Trust
As more patients are cared for using the solution, potentially beyond Western Sussex, the AKI scoring model could also be refined based on richer data from larger samples, as well as potentially being adapted for different circumstances and demographics.
Several hospitals have already expressed a strong interest to add the AKI application into their own early warning system software.