Key Elements of Clinical Communication After Inpatient Acute Kidney Injury: Modified Delphi Study From the AKINow Recovery Workgroup.

RATIONALE & OBJECTIVE

There is a lack of consensus on the key elements needed to foster clear and effective clinical communication after an episode of inpatient acute kidney injury (AKI). This study achieved consensus on key elements of AKI communication between inpatient and outpatient health care professionals.

STUDY DESIGN

Three sequential rounds of a modified Delphi process to develop, refine, and achieve consensus on items for inclusion in standardized post-AKI clinical communications. Each round included a survey followed by a virtual discussion.

SETTINGS & PARTICIPANTS

Forty-seven participants from 12 countries were recruited through purposive and snowball sampling, including 33 physicians (27 nephrologists), 10 allied health practitioners, and 4 patients and/or caregivers.

ANALYTIC APPROACH

Quantitative data were summarized using counts and percentages. Qualitative content analysis was performed to capture additional themes. Consensus recommendations (≥80% agreement) and qualitative findings were iteratively integrated into a draft communication guide.

RESULTS

Participants strongly agreed that post-AKI communication between health care teams should focus on medication changes and the description of the trends in serum creatinine. For patients requiring dialysis at discharge, the dates dialysis began and was last administered should be reported. Topics of post-AKI communication by clinicians to patients should focus on medication changes as well as follow-up testing and clinical monitoring. Qualitative evaluation highlighted that the effectiveness of a post-AKI communication guide depends on the systematic reporting of clinical information, the provision of actionable guidance for health care professionals and patients, and the promotion of kidney recovery monitoring.

LIMITATIONS

Potentially limited generalizability because participants were mostly health care practitioners from high-resource settings.

CONCLUSIONS

A multidisciplinary panel of stakeholders reached consensus on key elements of post-AKI clinical communication. The recommendations may valuably inform post-AKI care.

PLAIN-LANGUAGE SUMMARY

Communication among doctors and education of patients remains inconsistent after an episode of inpatient acute kidney injury (AKI). This study investigated the information that should be shared after discharge from the hospital after AKI. After receiving input and repeated feedback from a diverse group of health care professionals and patients who have experienced AKI, consensus was reached on key elements needed to guide standardized clinical communication of inpatient providers with patients and their outpatient providers. The study findings may be used to support better communication and follow-up care after a hospitalization that was complicated by AKI.