title: Development of guidance on the timeliness in response to acute kidney injury warning stage test results for adults in primary care: an appropriateness ratings evaluation.
abstract: Tackling the harm associated with acute kidney injury (AKI) is a global priority. In England, a national computerised AKI algorithm is being introduced across the National Health Service (NHS) to drive this change. The study sought to maximise its clinical utility and minimise the potential for burden on clinicians and patients in primary care.
  
  
  
  An appropriateness ratings evaluation using the RAND/UCLA Appropriateness Method.
  
  
  
  Clinical scenarios were developed to test the timeliness in (1) communication of AKI warning stage test results from clinical pathology services to primary care, and (2) primary care clinician response to an AKI warning stage test result.
  
  
  
  A 10-person panel was purposively sampled with representation from clinical biochemistry, acute and emergency medicine and general practice. General practitioners (GPs) represented typical practice in relation to rural and urban practice, out of hours care, GP commissioning and those interested in reducing the impact of medicalisation and 'overdiagnosis'.
  
  
  
  There was agreement that delivery of AKI warning stage test results through interruptive methods of communication (ie, telephone) from laboratories to primary care was the appropriate next step for patients with an AKI warning stage 3 test result. In the context of acute illness, waiting up to 72 hours to respond to an AKI warning stage test result was deemed an inappropriate action in 62 out of the 65 (94.5%) cases. There was agreement that a clinician response was required within 6 hours, or less, in 39 out of 40 (97.5%) clinical cases relating AKI warning stage test results in the presence of moderate hyperkalaemia.
  
  
  
  The study has informed national guidance to support a timely and calibrated response to AKI warning stage test results for adults in primary care. Further research is needed to support effective implementation, with a view to examine the effect on health outcomes and costs.
authors.affiliation: National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Blakeman
authors.affiliation: RCGP Clinical champion for Kidney Care, Royal College of General Practitioners, London, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Griffith
authors.affiliation: Department of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
authors.forename: Dan
authors.initials: D
authors.lastname: Lasserson
authors.affiliation: Department of Clinical Biochemistry, Norfolk and Norwich University Hospitals Foundation Trust, Norwich, UK.
authors.forename: Berenice
authors.initials: B
authors.lastname: Lopez
authors.affiliation: National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK.
authors.forename: Jung Y
authors.initials: JY
authors.lastname: Tsang
authors.affiliation: NIHR Greater Manchester Primary Care Patient Safety, Translational Research Centre, Institute of Population Health, Centre for Primary Care, University of Manchester, Manchester, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Campbell
authors.affiliation: Department of Renal Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Tomson
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000628:therapy; D000328:Adult; D000465:Algorithms; D001291:Attitude of Health Personnel; D001671:Biochemistry; D015415:Biomarkers; D002624:Chemistry, Clinical; D064790:Clinical Laboratory Services; D004635:Emergency Medicine; D058006:General Practice; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D013997:Time Factors; D006113:United Kingdom
chemical_list: D015415:Biomarkers
keywords: Acute Kidney Injury; Appropriateness; Minimally Disruptive Medicine; PRIMARY CARE; Quality of Healthcare