Quality standard

Quality statement 6: Clinical review after hospital discharge

Quality statement 6: Clinical review after hospital discharge

Quality statement

Adults discharged from hospital after acute kidney injury have a clinical review within 3 months, or sooner if they are at higher risk of poor outcomes. [new 2023]

Rationale

Adults discharged from hospital after acute kidney injury are at risk of serious ongoing health problems. A follow-up clinical review in primary or secondary care will help identify any issues and may prevent hospital readmission. Adults with a higher risk of poor outcomes may need an earlier review, for example, those with heart failure and poor kidney recovery may need a review within a few days of discharge.

Using a coordinated follow-up system across primary and secondary care can help ensure that it is clear where and when the review will take place. The timing of the review should take into account any other long-term conditions, and reflect the causes of the acute kidney injury, its severity and duration, and the degree of kidney recovery at discharge.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence that hospital discharge plans clearly identify an episode of acute kidney injury and include recommendations on timing and responsibility for follow-up clinical review.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, service protocols and discharge plans.

Process

Proportion of people discharged from hospital after acute kidney injury who have a clinical review within 3 months of discharge.

Numerator – the number in the denominator who have a clinical review within 3 months of discharge.

Denominator – the number of people discharged from hospital after acute kidney injury.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

a) Emergency readmissions to hospital within 30 days of discharge after acute kidney injury.

Data source: NHS Digital's Hospital Episode Statistics.

b) Emergency readmissions to hospital within 90 days of discharge after acute kidney injury.

Data source: NHS Digital's Hospital Episode Statistics.

What the quality statement means for different audiences

Service providers (hospitals and GP practices) ensure that hospital discharge procedures for adults after an episode of acute kidney injury include risk assessment and discharge plans with clear actions for the timing and setting for clinical review. Providers ensure that people discharged from hospital after acute kidney injury have a follow-up clinical review within 3 months of discharge or sooner if they are at higher risk of poor outcomes.

Healthcare professionals (such as doctors, nurses and pharmacists) carry out clinical reviews for people discharged from hospital after acute kidney injury within 3 months of discharge or sooner if they are at higher risk of poor outcomes.

Commissioners (integrated care boards) ensure that the services they commission carry out clinical reviews for people discharged from hospital after acute kidney injury within 3 months of discharge or sooner if they are at higher risk of poor outcomes.

People discharged from hospital after acute kidney injury have a review with their healthcare professional within 3 months of leaving hospital. Some people may be seen sooner, depending on their other health problems and how well their kidneys have recovered. The review will include assessing their medication, checking their kidney function and discussing how to maintain their kidney health.

Definitions of terms used in this quality statement

People discharged from hospital after acute kidney injury

All people discharged from hospital after an episode of acute kidney injury that occurred during their hospital stay, including those who were admitted to hospital for another reason. [Expert opinion]

Clinical review within 3 months or sooner

The review should include:

[Royal College of General Practitioners' Acute Kidney Injury toolkit, post-AKI care and NICE's clinical knowledge summary on acute kidney injury, management of acute kidney injury]

Suggested time frames for general practice clinical review following acute kidney injury are included in the Royal College of GPs' Acute Kidney Injury toolkit, post-AKI care, table 3.

A secondary care nephrology clinical review following acute kidney injury should be arranged:

  • within 90 days for those with residual chronic kidney disease stage G4 at hospital discharge

  • within 30 days for those with residual chronic kidney disease stage G5 (non-dialysis-requiring) at hospital discharge

  • within 30 days for those with ongoing dialysis requirements at the time of hospital discharge.

[The UK Kidney Association's (formerly the Renal Association) guideline on acute kidney injury, guideline 10.1. See table 1 in NICE's guideline on chronic kidney disease for details of the classification of chronic kidney disease]

Higher risk of poor outcomes

A higher risk of poor outcomes is associated with:

[Royal College of GPs' Acute Kidney Injury toolkit, post-AKI care, table 3]

Equality and diversity considerations

Adults should be given information that they can easily access and understand themselves, or with support, so they can communicate effectively with healthcare services. Clear language should be used, and the content and delivery of information should be tailored to individual needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate. For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.