Thursday, 4 March 2010

Acute Kidney Injury – getting down to business in North London

I visited the North Central London AKI Network recently to listen and learn about their approach to implementing the NCEPOD recommendations from “Adding Insult to Injury” and driving up quality. Hearing a patient story – a recollection of the unnecessary delays and missed opportunities – was a powerful way to set the tone and begin the discussions.

It was refreshing to see a multi-professional approach being adopted across the whole secondary care system in this patch with a focus on early identification of AKI risks, simplifying advice for busy junior doctors and nurses looking after acute admissions and working on surgical wards, and putting systems in place to provide timely, specialist input or transfer when needed.

There definitely are some quick wins – avoiding contrast induced nephropathy, automatic flagging of raised serum creatinine and mandating an AKI risk assessment as part of the admission protocol.

Chris Laing (Consultant Renal Physician, Royal Free) chaired the group and I think I very smart move was to get the Medical Directors of all 5 Acute Trusts in the North Central London cluster to be the sponsors of the Network. I was also pleased to see David Myers (President of the Royal Free KPA) is also a core member of the committee. It was the first time I had heard the “STOP” acronym to categorise the various causes of AKI that should be considered when the serum creatinine rises.

Chris and the group have the senior sponsors and are leading the cultural change to achieve “buy-in” across the system so that the pathways of care, flow diagrams and protocols that are being produced will have the best chance of getting embedded into routine practice. They aim to audit across their whole network and are exploring the use of CQUINS or inclusion of AKI metrics in quality accounts to maintain AKI on the agenda. I am sure the North Central London AKI Network would be pleased to share their approach and learning with other interested teams. I will be watching closely.