The UKRR NHS England National Programme for AKI

The UKRR NHS England National Programme for AKI - The National Picture Dr Fergus Caskey Medical Director of the UKRR, Bristol For the South West Cardiovascular Clinical Network, Sept 2015 A programme in partnership with

The UKRR From renal IT systems CKD 4/5, D-AKI and ESRD Renal Units LABS UK Renal Registry Patient HES, ONS etc

The UKRR: AKI direct from labs From renal IT systems CKD 4/5, D-AKI and ESRD Renal Units LABS Direct from labs AKI in 1 y and 2 y care UK Renal Registry Patient HES, ONS etc

The UKRR in The UKRDC From renal IT systems CKD 4/5, D-AKI and ESRD Renal Units LABS Direct from labs AKI in 1 y and 2 y care UK Renal Data Collaboration Patient Intersystems® data warehouse UK RR HES, ONS etc 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

AKI National Programme NHS England Patient Safety Steering Group AKI National Programme Board Risk Advisory Group Education Detection Algorithm Sub. Group Software Implementation Sub-Group Best Practice in Ealert Group Expert Reference Group Intervention Hydration Sub. Group Implementation Measurement

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 & e. GFR values for 15 months preceding and following the index AKI warning grade test result.

Results so far

AKI data returns, end July 2015 Lab Correct Lab Name Code No. of alerts format? AIREDALE NHS FOUNDATION TRUST LABORATORY 697 C 0 540 ü BRADFORD ROYAL INFIRMARY LABORATORY 690 H 0 3149 û BROOMFIELD HOSPITAL LABORATORY 692 V 0 717 ü CHELTENHAM GENERAL HOSPITAL 691 C 0 1468 û CHRISTIE HOSPITAL LABORATORY 696 F 0 239 ü COUNTY HOSPITAL LABORATORY 69240 1569 û DIANA, PRINCESS OF WALES HOSPITAL LAB 696 J 0 5785 ü DONCASTER ROYAL INFIRMARY LABORATORY 69180 750 ü FAZAKERLEY HOSPITAL LABORATORY 69020 2204 û HULL & EAST YORKSHIRE PATHOLOGY SERVICES 69460 758 û LEEDS GENERAL INFIRMARY LABORATORY 695 N 0 2877 û MEDWAY MARITIME HOSPITAL LABORATORY 692 T 0 3015 û NORFOLK & NORWICH HOSPITAL LABORATORY 69330 3059 ü NORTHERN GENERAL HOSPITAL LABORATORY 693 4158 û POOLE GENERAL HOSPITAL LABORATORY 693 S 0 6886 û PORTSMOUTH PATHOLOGY SERVICE 697 1777 û ROYAL LIVERPOOL UNIVERSITY HOSPITAL LAB 69470 2904 ü SALFORD ROYAL MICROBIOLOGY DEPARTMENT 697 T 0 2770 ü SOUTHAMPTON GENERAL HOSPITAL LABORATORY 694 X 0 1687 û SPS MUSGROVE PARK HOSPITAL 697 M 0 3096 û ST JAMES'S UNIVERSITY HOSP LABORATORY 696 B 0 4916 û THE ROYAL BOLTON HOSPITAL LABORATORY 690 F 0 1919 û UHSM NHS FOUNDATION TRUST LABORATORY 694 T 0 1867 û UNIVERSITY HOSP BIRMINGHAM LABORATORY 695 Q 0 4223 ü 698 E 0 110 ü Missing g 14 - Notes Address only filled in address line 1, IP/OP indicator field contains All OP? OP/IP indicators contains GP Sent in AKItests rows OP/IP indicators contains U * in egfr field IP/OP indicator field contains other values, Character values in Cr Address only filled in address line 1, IP/OP indicator field contains Character values in creatinine and Egfr, IP/OP indicator field contains "COM" IP/OP indicator field contains "DP" All IP? Character values in Egfr, IP/OP indicator field contains other values Address only filled in address line 1, IP/OP indicator field contains Addresses not filled in correct lines, IP/OP indicator field contains "COM" Remove from analysis, all fields black (except PII fields) So, 25 from a total number of labs ~ 180

AKI data completeness Lab Name AIREDALE NHS FOUNDATION TRUST LABORATORY BRADFORD ROYAL INFIRMARY LABORATORY BROOMFIELD HOSPITAL LABORATORY CHELTENHAM GENERAL HOSPITAL CHRISTIE HOSPITAL LABORATORY COUNTY HOSPITAL LABORATORY DIANA, PRINCESS OF WALES HOSPITAL LABORATORY DONCASTER ROYAL INFIRMARY LABORATORY FAZAKERLEY HOSPITAL LABORATORY HULL & EAST YORKSHIRE PATHOLOGY SERVICES LEEDS GENERAL INFIRMARY LABORATORY MEDWAY MARITIME HOSPITAL LABORATORY NORFOLK & NORWICH HOSPITAL LABORATORY NORTHERN GENERAL HOSPITAL LABORATORY POOLE GENERAL HOSPITAL LABORATORY PORTSMOUTH PATHOLOGY SERVICE ROYAL LIVERPOOL UNIVERSITY HOSPITAL LABORATORY SALFORD ROYAL MICROBIOLOGY DEPARTMENT SOUTHAMPTON GENERAL HOSPITAL LABORATORY SPS MUSGROVE PARK HOSPITAL ST JAMES'S UNIVERSITY HOSP LABORATORY THE ROYAL BOLTON HOSPITAL LABORATORY UHSM NHS FOUNDATION TRUST LABORATORY UNIVERSITY HOSP BIRMINGHAM LABORATORY Lab Code 697 C 0 690 H 0 692 V 0 691 C 0 696 F 0 69240 696 J 0 69180 69020 69460 695 N 0 692 T 0 69330 693 S 0 697 69470 697 T 0 694 X 0 697 M 0 696 B 0 690 F 0 694 T 0 695 Q 0 698 E 0 Post. IP/OP Sex DOB code (correct) 100 69. 26 100 100 99. 97 99. 46 85. 17 100 92. 19 100 0 100 85. 76 100 99. 58 100 100 99. 68 99. 87 100 99. 34 100 100 99. 73 82. 12 100 100 100 99. 86 73. 69 100 74. 21 77. 4 100 97. 97 100 99. 98 99. 93 0 100 100 98. 4 100 99. 94 99. 77 97. 86 100 98. 24 100 100 98. 95 99. 93 100 99. 64 88. 62 100 99. 55 88. 31 100 99. 98 85. 98 100 99. 9 76. 97 100 99. 52 99. 84 100 99. 6 99. 91 100 100 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 1 AKI 2 AKI 3 AKI stage 1 2 3 Sex (% M) 50. 57 51. 36 59. 66 Age (Median, IQR) 73. 09 (58. 97, 82. 82) 71. 83 (58. 38, 81. 7) 70. 65 (57. 74, 80. 41)

Distribution of AKI levels: S West 70 60 50 AKI 1 40 AKI 2 AKI 3 30 Missing 20 10 0 CHELTENHAM POOLE PORTSMOUTH SOUTHAMPTON MUSGROVE PARK 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

Acknowledgements Thank 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. A programme in partnership with www. renalreg. com @UKRenal. Registry