Implementing post-discharge care following acute kidney injury in England: a single-centre qualitative evaluation

Abstract

ObjectivesWe sought to understand the factors influencing the implementation of a primary care intervention to improve post-discharge care following acute kidney injury (AKI).DesignQualitative study using semi-structured interviews and thematic analysis.SettingGeneral practices in one Clinical Commissioning Group area in England.ParticipantsA total of 18 healthcare staff took part in interviews. Participants were practice pharmacists, general practitioners, practice managers and administrators involved in implementing the intervention.ResultsWe identified three main factors influencing implementation: differentiation of the new intervention from other practice work; development of skill mix and communication across organisations. Overall, post-AKI processes of care were deemed straightforward to embed into existing practice. However, it was also important to separate the intervention from other work in general practice. Dedicating staff time to proactively identify AKI on discharge summaries and to coordinate the provision of care enabled implementation of the intervention. The post-AKI intervention provided an opportunity for practice pharmacists to expand their primary care role. Working in a new setting also brought challenges; time to develop trusting relationships including an understanding of boundaries of clinical expertise influenced pharmacists’ roles. Unclear and inconsistent information on discharge summaries contributed to concerns about additional work in primary care.ConclusionsThe research highlights challenges around post-discharge management in the primary care context. Coordination and communication were key factors for improving follow-up care following AKI. Further consideration is required to understand patient experiences of the interface between secondary and primary care. The issues pertaining to discharge care following AKI are relevant to practitioners and commissioners as they work to improve transitions of care for vulnerable patient populations.

Post-discharge care following acute kidney injury: quality improvement in primary care

“…The analysis of our qualitative data showed that the events were generally well received. 34 Participants reported that after attending, they felt better equipped to implement the intervention. GPs and practice managers welcomed the opportunity to find out how their peers in local practices were approaching implementation, while pharmacists particularly appreciated the clinical content which helped increase their knowledge about kidney health.…”

“…However, others felt constraints of their roles limited potential involvement in care for patients following AKI. 34 …”

“… 47 Feedback from practices indicated that CCG support and endorsement was, for them, important. 34 The combination of these two elements, along with alignment with best practice, was a strength of the study design. The role of the practice-based pharmacists was seen as beneficial in the implementation of action plans.…”

“…A qualitative process evaluation was also conducted alongside this study to aid understanding of AKI-related working practices in primary care, the data from which Open access are published separately. 34 Elements of these findings have been included in this report where relevant.…”

Discharge Documentation and Follow-Up of Critically Ill Patients With Acute Kidney Injury Treated With Kidney Replacement Therapy: A Retrospective Cohort Study

“…Of equal importance to the clinical information that a discharge document holds is its use for coding and reimbursement purposes. Failure to record an episode of AKI treated with KRT can have serious implications and affect patients' future or long-term management ( 34 ).…”