In 2009, the findings of the National Confidential Enquiry into Patient Outcomes and Deaths (NCEPOD AKI-Adding Insult to Injury) highlighted a scandal of patient mismanagement in our health system. The overall quality of care received by the majority of AKI patients was poor and the executive summary highlighted that  outcomes  were due to deficiencies in the clinicians managing those patients.

The report headlines were damning:

“deficiencies in AKI care are primarily related to the clinicians”

“lack of awareness of the inherent risk of AKI”

“ a poor understanding of the pathophysiology”

“inadequate knowledge of its  management amongst medical staff”

“deficiencies in training both at undergraduate and post graduate level”

Most NHS Trusts have excellent AKI bundles available as online resources and on posters that are periodically placed around AMUs and EDs. The problem is that our “coalface clinicians” fail to identify AKIs and consequently do not engage with detailed clinical bundles on Trust websites. As a renal physician, I receive advice calls from juniors across all specialities. Mismanagement of AKI is a recurrent theme and this hasn’t changed over the years. Austin has always been impressed with the SEPSIS 6 campaign in that it has been adopted by students and junior clinicians alike. The bundle is simple enough to be memorised- and although it compromises on detail it promotes patient safety by ensuring the basics are done at the front door. He felt that we needed a similar approach for AKI patients.

At SAM Westminster in 2021, Austin pitched the idea of a simplified national AKI bundle to then President of SAM, Tim Cooksley . Austin felt AKI had fallen in between 2 specialities: Nephrology appeared to have ownership of AKI-yet 60% of the hospital  AKIs were occurring in AMUs and ED. Tim agreed the AKI was core business for acute medicine and suggested Austin helped to form a special interest group (SIG) to raise the profile of AKI .The AKI SIG working group then met at Manchester SAM (the group included Darren Green and John Murray-who chairs the national AKI SIG).

As a SAM SIG we had a voice at national meetings and over the course of 2 years were able to attract support for the idea of a simplified AKI bundle  from various expert committees (including National AKI SIG , Renal services Transformation Programme, UK Kidney Association ,AKI COP nurses). Roundup was presented at 3 National conferences and the final bundle resulted from feedback received and discussions at AKI SIG.

In September 2023 the national  NHS AKI Strategy Summit was held in Birmingham and there was representation from across the NHS. AKI bundles from across the UK were reviewed and the delegates voted for Roundup as the preferred  AKI bundle. The summit  strategy report is due out later this year.

The challenge now is how to achieve for AKI what Sepsis6 did for surviving sepsis-and promote a simplified national AKI bundle so that it is adopted by our PAs, ANPs and junior doctors manning the emergency admission pathways.