The UKRR NHS EnglandNational Programme for AKI

- The National Picture -

Dr Fergus CaskeyMedical Director of the UKRR, Bristol

For the South West Cardiovascular Clinical Network, Sept 2015

A programme in partnership with

UK Renal Registry

Patient

Renal Units LABSLABS

LABS

The UKRRFrom renal IT systemsCKD4/5, D-AKI and ESRD

HES, ONS etc

UK Renal Registry

Patient

Renal Units LABSLABS

LABS

The UKRR: AKI direct from labsFrom renal IT systemsCKD4/5, D-AKI and ESRD

HES, ONS etc

Direct from labsAKI in 1y and 2y care

UK Renal Data Collaboration

UK RR

Patient

Renal Units LABSLABS

LABS

The UKRR in The UKRDC

Intersystems® data warehouse

From renal IT systemsCKD4/5, D-AKI and ESRD

Direct from labsAKI in 1y and 2y care

NOTE: This diagram has excluded other members of the UKRDC to reduce complexity in explaining the collection of UKRR data. Other members of the UKRDC

include BAPN, the Scottish Renal Registry, RADAR, Patient View and NHSBT

HES, ONS etc

AKI National Programme Board

Risk Education Detection ImplementationIntervention Measurement

NHS England Patient Safety Steering Group

Hydration Sub-Group

Software Implementation Sub-Group

Algorithm Sub-Group

Best Practice in E-alert Group

Expert Reference Group

Advisory Group

AKI National Programme

National algorithm mandate to report

Section 251 exemption

AKI data specification

https://www.thinkkidneys.nhs.uk/resources/

Data specification – warning grade

Data specification – creat pre & post

All serum creatinine & eGFR values for 15 months preceding and following the index AKI warning grade test result.

Results so far

AKI data returns, end July 2015Lab Name

Lab Code No. of alerts

Correct format? Notes

AIREDALE NHS FOUNDATION TRUST LABORATORY 697C0 540 üBRADFORD ROYAL INFIRMARY LABORATORY 690H0 3149 û Address only filled in address line 1, IP/OP indicator field containsBROOMFIELD HOSPITAL LABORATORY 692V0 717 ü All OP?CHELTENHAM GENERAL HOSPITAL 691C0 1468 û OP/IP indicators contains GPCHRISTIE HOSPITAL LABORATORY 696F0 239 ü Sent in AKItests rowsCOUNTY HOSPITAL LABORATORY 69240 1569 û OP/IP indicators contains UDIANA, PRINCESS OF WALES HOSPITAL LAB 696J0 5785 ü * in egfr fieldDONCASTER ROYAL INFIRMARY LABORATORY 69180 750 üFAZAKERLEY HOSPITAL LABORATORY 69020 2204 û IP/OP indicator field contains other values, Character values in CrHULL & EAST YORKSHIRE PATHOLOGY SERVICES 69460 758 û Address only filled in address line 1, IP/OP indicator field containsLEEDS GENERAL INFIRMARY LABORATORY 695N0 2877 û Address only filled in address line 1, IP/OP indicator field contains MEDWAY MARITIME HOSPITAL LABORATORY 692T0 3015 û Character values in creatinine and Egfr, IP/OP indicator fieldNORFOLK & NORWICH HOSPITAL LABORATORY 69330 3059 üNORTHERN GENERAL HOSPITAL LABORATORY 693 4158 û Character values in creatinine and Egfr, IP/OP indicator fieldPOOLE GENERAL HOSPITAL LABORATORY 693S0 6886 û IP/OP indicator field contains "COM"PORTSMOUTH PATHOLOGY SERVICE 697 1777 û IP/OP indicator field contains "DP"ROYAL LIVERPOOL UNIVERSITY HOSPITAL LAB 69470 2904 ü All IP?SALFORD ROYAL MICROBIOLOGY DEPARTMENT 697T0 2770 üSOUTHAMPTON GENERAL HOSPITAL LABORATORY 694X0 1687 û Character values in Egfr, IP/OP indicator field contains otherSPS MUSGROVE PARK HOSPITAL 697M0 3096 û IP/OP indicator field contains other valuesST JAMES'S UNIVERSITY HOSP LABORATORY 696B0 4916 û Address only filled in address line 1, IP/OP indicator field contains THE ROYAL BOLTON HOSPITAL LABORATORY 690F0 1919 û Addresses not filled in correct lines, IP/OP indicator field contains UHSM NHS FOUNDATION TRUST LABORATORY 694T0 1867 û IP/OP indicator field contains "COM"UNIVERSITY HOSP BIRMINGHAM LABORATORY 695Q0 4223 ü

698E0 110 ü

Missing Missing 14 - Remove from analysis, all fields black (except PII fields)

So, 25 from a total number of labs ~ 180

AKI data completeness

Lab Name Lab Code Sex DOBPost-code

IP/OP (correct)

AIREDALE NHS FOUNDATION TRUST LABORATORY 697C0 100 69.26 100 100BRADFORD ROYAL INFIRMARY LABORATORY 690H0 100 99.97 99.46 85.17BROOMFIELD HOSPITAL LABORATORY 692V0 100 100 92.19 100CHELTENHAM GENERAL HOSPITAL 691C0 100 0 100 85.76CHRISTIE HOSPITAL LABORATORY 696F0 100 100 99.58 100COUNTY HOSPITAL LABORATORY 69240 100 100 99.68 99.87DIANA, PRINCESS OF WALES HOSPITAL LABORATORY 696J0 100 100 99.34 100DONCASTER ROYAL INFIRMARY LABORATORY 69180 100 100 100 100FAZAKERLEY HOSPITAL LABORATORY 69020 100 100 99.73 82.12HULL & EAST YORKSHIRE PATHOLOGY SERVICES 69460 100 100 100 100LEEDS GENERAL INFIRMARY LABORATORY 695N0 100 100 99.86 73.69MEDWAY MARITIME HOSPITAL LABORATORY 692T0 100 100 74.21 77.4NORFOLK & NORWICH HOSPITAL LABORATORY 69330 100 100 97.97 100NORTHERN GENERAL HOSPITAL LABORATORY 693 100 99.98 99.93 0POOLE GENERAL HOSPITAL LABORATORY 693S0 100 100 100 98.4PORTSMOUTH PATHOLOGY SERVICE 697 100 99.94 99.77 97.86ROYAL LIVERPOOL UNIVERSITY HOSPITAL LABORATORY 69470 100 100 98.24 100SALFORD ROYAL MICROBIOLOGY DEPARTMENT 697T0 100 100 98.95 99.93SOUTHAMPTON GENERAL HOSPITAL LABORATORY 694X0 100 100 99.64 88.62SPS MUSGROVE PARK HOSPITAL 697M0 100 100 99.55 88.31ST JAMES'S UNIVERSITY HOSP LABORATORY 696B0 100 100 99.98 85.98THE ROYAL BOLTON HOSPITAL LABORATORY 690F0 100 100 99.9 76.97UHSM NHS FOUNDATION TRUST LABORATORY 694T0 100 100 99.52 99.84UNIVERSITY HOSP BIRMINGHAM LABORATORY 695Q0 100 99.6 99.91 100 698E0 100 100 98.18 100

AKI by stage

Total number of cases = 62,436

• AKI level 1 = 39,004 (62%)• AKI level 2 = 11,575 (18%)• AKI level 3 = 11,857 (19%)

AKI 1AKI 2AKI 3

AKI stage Sex (% M) Age (Median, IQR)1 50.57 73.09 (58.97, 82.82)2 51.36 71.83 (58.38, 81.7)3 59.66 70.65 (57.74, 80.41)

Distribution of AKI levels: S West

CHELTENHAM POOLE PORTSMOUTH SOUTHAMPTON MUSGROVE PARK0

10

20

30

40

50

60

70

AKI 1AKI 2AKI 3Missing

Note: The number of months that these data refer to may vary.

Next steps• Automate AKI file format checking• Explore any inconsistencies in the AKI warning test result data

and feedback to:– Labs– Detection workstream (algorithm)

• Examine the serum creatinine files (from +/- 15 months)• Work through analysis plan

– Data validation– Audit, quality improvement and research

• Publish compliance with reporting• Publish non-compliance with reporting

AcknowledgementsThank you to all the healthcare professionals and patients who are participating in the Registry’s National Programme on AKI. In particular the Measurement Workstream is led by Dr Nitin Kohle (nephrologist, Derby) and Dr Dan Lasserson (GP, Oxford). Becci Evans at the Registry is the lead statistician on this work.

Thank you to colleagues at NHS England for their support and advice in delivering this programme and in particular Dr Richard Fluck, National Clinical Director. Thank you also to all the people at the Registry, led by Ron Cullen, who work in the background to make all this possible.

@UKRenalRegistrywww.renalreg.com

A programme in partnership with