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

UK Renal Registry Patient Renal Units LABS The UKRR From renal IT systems CKD4/5, D-AKI and ESRD HES, ONS etc

UK Renal Registry Patient Renal Units LABS The UKRR: AKI direct from labs From renal IT systems CKD4/5, D-AKI and ESRD HES, ONS etc Direct from labs AKI in 1y and 2y care

UK Renal Data Collaboration UK RR Patient Renal Units LABS The UKRR in The UKRDC Intersystems® data warehouse From renal IT systems CKD4/5, D-AKI and ESRD Direct from labs AKI 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 RiskEducation DetectionImplementationInterventionMeasurement 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

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 2015 Lab Name Lab CodeNo. of alerts Correct format?Notes AIREDALE NHS FOUNDATION TRUST LABORATORY697C0540 BRADFORD ROYAL INFIRMARY LABORATORY690H03149  Address only filled in address line 1, IP/OP indicator field contains BROOMFIELD HOSPITAL LABORATORY692V0717 All OP? CHELTENHAM GENERAL HOSPITAL691C01468  OP/IP indicators contains GP CHRISTIE HOSPITAL LABORATORY696F0239 Sent in AKItests rows COUNTY HOSPITAL LABORATORY  OP/IP indicators contains U DIANA, PRINCESS OF WALES HOSPITAL LAB696J05785 * in egfr field DONCASTER ROYAL INFIRMARY LABORATORY FAZAKERLEY HOSPITAL LABORATORY  IP/OP indicator field contains other values, Character values in Cr HULL & EAST YORKSHIRE PATHOLOGY SERVICES  Address only filled in address line 1, IP/OP indicator field contains LEEDS GENERAL INFIRMARY LABORATORY695N02877  Address only filled in address line 1, IP/OP indicator field contains MEDWAY MARITIME HOSPITAL LABORATORY692T03015  Character values in creatinine and Egfr, IP/OP indicator field NORFOLK & NORWICH HOSPITAL LABORATORY NORTHERN GENERAL HOSPITAL LABORATORY  Character values in creatinine and Egfr, IP/OP indicator field POOLE GENERAL HOSPITAL LABORATORY693S06886  IP/OP indicator field contains "COM" PORTSMOUTH PATHOLOGY SERVICE  IP/OP indicator field contains "DP" ROYAL LIVERPOOL UNIVERSITY HOSPITAL LAB All IP? SALFORD ROYAL MICROBIOLOGY DEPARTMENT697T02770 SOUTHAMPTON GENERAL HOSPITAL LABORATORY694X01687  Character values in Egfr, IP/OP indicator field contains other SPS MUSGROVE PARK HOSPITAL697M03096  IP/OP indicator field contains other values ST JAMES'S UNIVERSITY HOSP LABORATORY696B04916  Address only filled in address line 1, IP/OP indicator field contains THE ROYAL BOLTON HOSPITAL LABORATORY690F01919  Addresses not filled in correct lines, IP/OP indicator field contains UHSM NHS FOUNDATION TRUST LABORATORY694T01867  IP/OP indicator field contains "COM" UNIVERSITY HOSP BIRMINGHAM LABORATORY695Q E0110 Missing 14-Remove from analysis, all fields black (except PII fields) So, 25 from a total number of labs ~ 180

AKI data completeness Lab NameLab CodeSexDOB Post- code IP/OP (correct) AIREDALE NHS FOUNDATION TRUST LABORATORY697C BRADFORD ROYAL INFIRMARY LABORATORY690H BROOMFIELD HOSPITAL LABORATORY692V CHELTENHAM GENERAL HOSPITAL691C CHRISTIE HOSPITAL LABORATORY696F COUNTY HOSPITAL LABORATORY DIANA, PRINCESS OF WALES HOSPITAL LABORATORY696J DONCASTER ROYAL INFIRMARY LABORATORY FAZAKERLEY HOSPITAL LABORATORY HULL & EAST YORKSHIRE PATHOLOGY SERVICES LEEDS GENERAL INFIRMARY LABORATORY695N MEDWAY MARITIME HOSPITAL LABORATORY692T NORFOLK & NORWICH HOSPITAL LABORATORY NORTHERN GENERAL HOSPITAL LABORATORY POOLE GENERAL HOSPITAL LABORATORY693S PORTSMOUTH PATHOLOGY SERVICE ROYAL LIVERPOOL UNIVERSITY HOSPITAL LABORATORY SALFORD ROYAL MICROBIOLOGY DEPARTMENT697T SOUTHAMPTON GENERAL HOSPITAL LABORATORY694X SPS MUSGROVE PARK HOSPITAL697M ST JAMES'S UNIVERSITY HOSP LABORATORY696B THE ROYAL BOLTON HOSPITAL LABORATORY690F UHSM NHS FOUNDATION TRUST LABORATORY694T UNIVERSITY HOSP BIRMINGHAM LABORATORY695Q E

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 stageSex (% M)Age (Median, IQR) (58.97, 82.82) (58.38, 81.7) (57.74, 80.41)

Distribution of AKI levels: S West 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 A programme in partnership with