cAKI QI Project SPARC - Salford Partnership for Advancing Renal Care Innovation fund grant accepted (Salford CCG) IS4leaders (HAELO) supported

1. cAKI QI Project
Innovation fund grant accepted
(Salford CCG)
IS4leaders (HAELO) supported
SPARC
Salford Partnership for Advancing Renal Care
James Tollitt ST6 Nephrology

2. The problem: AKI
•10-20% of hospital admissions suffer AKI
•50% of patients received “good care”(1)
•30% of deaths were preventable(1)
1. National Confidential Enquiry into Patient Outcome and Death (NCEPOD)
2009. Acute Kidney Injury: Adding Insult to Injury

3. 2/3rd of AKI is community acquired
Selby N et al. CJASN 2012; 7(4): 533

4. The cAKI Problem
AKI in primary care
1. cAKI is less studied
2. 0.5-6% amongst available measurements 1,2
3. 5.3 increased odds ratio of 30 day mortality 2
4. Are NCEPOD issues for secondary care same
for primary care (recognition, assessment of
risk factors, standard of care provided)?
1. Barton AL et al “One Year's Observational Study of Acute Kidney Injury Incidence in Primary Care; Frequency
of Follow-Up Serum Creatinine and Mortality Risk.” Nephron. Epub 2015 Jun 19.
2. Hobbs H et al “ Do acute elevations of serum creatinine in primary care engender an increased mortality risk?
BMC Nephrol. 2014 Dec.

6. Project Overview
Who are we?
• Smeeta Sinha
– Renal Clinical Director at SRFT
• Sheila McCorkindale
– GP/ CCG lead for diabetes and kidney health/ local clinical research specialty lead
• Dimitrios Poulikakos
– Renal consultant at SRFT/AKI lead
• James Tollitt
– Renal ST6 (specialist trainee) at SRFT
• Sam Glyn Atkins
– Service Improvement Manager at Salford CCG
With grateful contributions from
SRFT admin staff and Emma Flanagan

7. Charter
What are we trying to accomplish?
• Raise awareness of AKI and realise its importance in the eyes
of primary care
• Establish a precedent for like minded CCG’s to work together
collaboratively
• We want to develop tools (guidelines, apps, templates etc.) to
aid management of AKI in primary care
• Establish if AD is a feasible methodology

8. Charter
Why?
Ultimately improve care for patients with AKI, earlier
intervention will translate into fewer patients progressing to
more severe AKI and fewer patients requiring hospitalisation

9. Aim
Reduce community acquired AKI admitted to Salford
Royal Hospital by 10% by June 2016
(No of AKI 1,2,3 divided by no of patients registered in
Salford)
Secondary Outcomes
• Engagement of GP’s in AKI (only relates to AD Primary
driver)
• Time to second UE test following alert
• Length of stay in AKI
Balancing Measure
• Number of community requested UE blood tests

10. How are we going to achieve this?
1. Community e-alerts (switch on is controlled by us)
2. Academic Detailing (us)
1. Peer to peer
2. 1 to 1
3. Clear educational objectives
4. Interactive
5. Evidence based and case based
3. Sick Day Rule campaign with pharmacist input
1. Pharmacists visiting 50% of Salford practices and discussing
medicine management with patients and GPs in relation to AKI
(CLAHRC funded and delivered)

12. Factorial Design(1) of Project
25% of patients in Salford have had AKI e-alerts switched on and no academic
detailing
25% of patients in Salford will have AKI e-alerts switched on and undergo AD
White group is essentially our control group who have no alert and no AD and
only half of these have pharmacist input to discuss medicines management in
relation to sick day rules
46 Salford ccg practices has been amalgamated into 40 and randomised:
1.Moen RD, Nolan TW, Provost LP. 1991 Quality Improvement through planned experimentation. New York. USA:McgGraw-Hill
25% of patients in Salford will have AD but without AKI e-alert

13. Factorial Designof Project
Randomisation:
46 GP practices were re-organised into 40
units.
The practices were randomised according to
size
Each group has 5 units

14. Work Done
• Created a data dashboard
– Automatically fills spreadsheet with
• cAKI incidence and location
• Time to repeat blood test
• Time in AKI
• Severity of AKI
• PDSA’s around
– GP engagement- GP interviews
– Design of the academic detailing itself
– Design of a pre AD questionnaire

15. In summary
Work is still very much ongoing
What has been key:
• Collaboration and joint working via SPARC
• SCCG commitment to innovation and research
• Support from
– NIHR CLAHRC Greater Manchester
– Derby CCG
– NHS Highland
– CMFT
– Think Kidneys

16. Thank you for listening
Any questions?
SPARC
Salford Partnership for Advancing Renal Care