Tsang Jung Yin, Murray Jonathan, Kingdon Edward, Tomson Charlie, Hallas Kyle, Campbell Stephen, Blakeman Tom
National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care and Health Services Research, Institute of Population Health, University of Manchester, Manchester, UK
NIHR Greater Manchester Patient Safety Translational Research Centre (PTSRC), University of Manchester, Manchester, UK.
BJGP Open. 2020 Aug 25;4(3). doi: 10.3399/bjgpopen20X101054. Print 2020 Aug.
Acute kidney injury (AKI) is associated with poor health outcomes, including increased mortality and rehospitalisation. National policy and patient safety drivers have targeted AKI as an example to ensure safer transitions of care.
To establish guidance to promote high-quality transitions of care for adults following episodes of illness complicated by AKI.
DESIGN & SETTING: An appropriateness ratings evaluation was undertaken using the RAND/UCLA Appropriateness Method (RAM). The Royal College of General Practitioners (RCGP) AKI working group developed a range of clinical scenarios to help identify the necessary steps to be taken following discharge of a patient from secondary care into primary care in the UK.
A 10-person expert panel was convened to rate 819 clinical scenarios, testing the most appropriate time and action following hospital discharge. Specifically, the scenarios focused on determining the appropriateness and urgency for planning: an initial medication review; monitoring of kidney function; and assessment for albuminuria.
Taking no action (that is, no medication review; no kidney monitoring; or no albuminuria testing) was rated inappropriate in all cases. In most scenarios, there was consensus that both the initial medication review and kidney function monitoring should take place within 1-2 weeks or 1 month, depending on clinical context. However, patients with heart failure and poor kidney recovery were rated to require expedited review. There was consensus that assessment for albuminuria should take place at 3 months after discharge following AKI.
Systems to support tailored and timely post-AKI discharge care are required, especially in high-risk populations, such as people with heart failure.
急性肾损伤（AKI）与不良健康结局相关，包括死亡率增加和再次住院。国家政策和患者安全推动因素将AKI作为确保更安全的护理过渡的一个范例。
制定指南，以促进成年患者在发生并发AKI的疾病发作后实现高质量的护理过渡。
使用兰德/加州大学洛杉矶分校适当性方法（RAM）进行了适当性评级评估。皇家全科医师学院（RCGP）AKI工作组制定了一系列临床场景，以帮助确定在英国患者从二级护理出院进入初级护理后应采取的必要步骤。
召集了一个由10人组成的专家小组，对819个临床场景进行评级，测试出院后最合适的时间和行动。具体而言，这些场景侧重于确定规划的适当性和紧迫性：初步药物审查；肾功能监测；以及白蛋白尿评估。
在所有情况下，不采取任何行动（即不进行药物审查；不进行肾脏监测；或不进行白蛋白尿检测）被评为不适当。在大多数场景中，专家们达成共识，即根据临床情况，初步药物审查和肾功能监测均应在1 - 2周或1个月内进行。然而，心力衰竭且肾脏恢复不佳的患者被评为需要加快审查。专家们达成共识，白蛋白尿评估应在AKI出院后3个月进行。
需要建立支持AKI出院后量身定制且及时护理的系统，尤其是在高危人群中，如心力衰竭患者。
