Management of Acute Kidney Injury in Primary Care: Development and evaluation of a model for Learning & Improvement - RCGP toolkit

Greater ManchesterRenal and Urogenital
Start Date: 1 Sep 2017 End Date: 31 Dec 2018

About the project

CLAHRC GM is working in collaboration with medical practices across the Manchester Health and Care Commissioning and AKI Leads at Central Manchester University Hospital NHS Foundation Trust to identify processes of care and management of patients with Acute Kidney Injury (AKI) between secondary and primary care. Using a quality improvement approach of testing and sharing learning, we aim to explore:

  • Processes to improve communication of AKI between secondary and primary care;
  • Processes to improve diagnosis and coding of AKI;
  • Timely care and surveillance (e.g. serum creatinine checks; medication reviews and information given to patients as per national guidelines).

Facilitating the collaboration between secondary and primary care is at the core of this project, by creating a strong relationships between the teams and sharing important information to inform improvement at the interface between hospital and general practice care going forward.

Why is it important?

AKI is a major marker of patient safety and illness severity. Illness complicated by AKI is associated with poor health outcomes in terms of high rates of rehospitalisation, development or progression of Chronic Kidney Disease (CKD), and mortality. NHS England has introduced a Level 3 Patient Safety Directive to improve the recognition and response to AKI.

As a clinical syndrome, AKI offers a lens to learn and improve care delivery and patient safety for people with a range of conditions, particularly those taking multiple medicines and living with complex health and social care needs (i.e. multi-morbidity).

Contribution of CLAHRC GM

With a small number of general practices, in collaboration with the AKI team at Central Manchester University Hospitals NHS Foundation Trust, CLAHRC GM have explored the processes of care for patients who have had illness complicated by AKI, or have received a warning stage test alert, and identified barriers and systems to improve care. Each practice conducted casenote reviews on patients, and the key lessons learned with the practice teams were identified. This work has also fed into a National initiative led by the Royal College of GPs (RCGP) which has resulted in the development of AKI toolkit for the management of AKI patients within primary care.


Manchester Health and Care Commissioning

Manchester University NHS Foundation Trust

Royal Collage of General Practitioners

Susan Howard