WIP 25 - Improving Recognition of Neonatal AKI and Ensuring Post-Discharge Follow Up

Publication Number: WIP 25.7701

Celia Willard, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Jessica Reid-Adam, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Courtney Juliano, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Richelle Reinhart, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Andrea Weintraub, Icahn School of Medicine at Mount Sinai, White or Caucasian, NY, United States

Background: Neonatal acute kidney injury (AKI) is prevalent in premature and/or growth-restricted infants, and can significantly impact long-term health. Implementation of timely post-discharge renal follow-up for patients with AKI remains a challenge. Lack of clear consensus guidelines for referral and failure to recognize and document AKI contributes to inconsistent follow-up of these patients.

Objective: The aim of this quality improvement initiative is to increase the rate of AKI identification and post discharge follow-up. The SMART aim of this project is that at least 95% of eligible infants (birthweight < 3rd%ile and/or AKI) have follow-up with nephrology scheduled at discharge by March 2025.

Design/Methods: The outcome measure is the percentage of patients with a history of AKI or birth weight < 3% and a scheduled follow-up appointment prior to discharge (evaluated with p-charts). The process measures include percentage of appropriate documentation of AKI on the patient’s EMR problem list and percentage of documentation of AKI in the discharge summary (p-charts). The balancing measures are the number of inpatient renal consults and inappropriate follow-up appointments. Serial interventions are ongoing and planned, including: collaboration between neonatology and nephrology to create guidelines for referral indications and appointment intervals, audits and feedback to discharging providers, and EMR changes for sustainability and consistent adherence to the new guidelines (updates to the discharge checklist SmartPhrase and Discharge Summary SmartText with details of the new guidelines). NICU physicians and frontline providers were surveyed to assess familiarity with diagnosis of AKI and post-discharge practices. Based on the results of the survey, educational sessions for NICU providers on AKI are planned. Effects of these interventions are being studied currently.