Patients’ navigation of care following a hospital admission: Early qualitative insights from a national study of post discharge care for people affected by Acute Kidney Injury

Problem

Acute kidney injury (AKI) is a common, harmful and costly clinical syndrome. It is a marker of illness severity, characterised by sudden worsening in kidney function. People affected by AKI experience potentially avoidable adverse outcomes following hospital discharge including high rates of unplanned readmissions and poor long-term health outcomes. Because AKI affects so many people each year, improved post-discharge care is particular important. As a clinical syndrome that is particularly relevant to care for people living with multiple long-term conditions. It is therefore important that an AKI diagnosis is placed in context, enabling tailored and timely follow-up that takes into account an individual’s existing co-morbidities, social circumstances and prognosis. To date, AKI research and quality improvement initiatives have largely examined organisational and provider working practices with little attention to exploring the everyday work undertaken by patients following hospital discharge.

Approach

Patients who had an episode of care complicated by AKI were identified by clinical care teams at different hospitals and consent to contact forms passed to the research team. Semi-structured interviews were conducted remotely via telephone, or online, with patients after they had left hospital up to four weeks post discharge. Interviews explored patient experiences of an AKI with a particular focus on the discharge process, their navigation and coordination of follow-up arrangements and the context of other complex health and social needs.Thematic analysis drew upon the personal holistic accounts and experiences of patients to capture an understanding of the work that patients did to navigate their care.

Findings

Twenty-four patients, with different presentations of AKI and varying complex needs from six hospitals, took part in semi-structured interviews. Emerging analysis of transcripts revealed that patients undertook work in the period after hospital discharge to understand their kidney health, to deal with anxieties about their health and to stay healthy at home. This work was often in the context of other pre-existing co-morbidities. Patients often navigated their health care working to manage attendance at follow-up appointments. Follow-up for the AKI was often separate from other follow-up requiring multiple appointments, with different specialist teams, sometimes in different locations. Navigating these care pathways and coordinating their own care was a challenge for patients.

Consequences

Patient understanding of their kidney health was coupled with their own co-ordination and navigation of care after discharge from hospital. This created additional treatment burden for patients. Further work is needed to understand how patients can be better supported to navigate their care following an admission complicated by AKI and hence improve health outcomes.