Acute Kidney Outreach to Reduce Deterioration and Death (AKORDD)

"The Outreach team will advise on an evidence-based package of care:~1\) Rapidly establish a credible diagnosis of the cause of AKI including:~1. Improved assessment of volume status~2. Standardised use of urine dipstick .~3. Appropriate sepsis investigations.~4. Urgent ultrasound with suspected obstruction."

Rapid, limited treatment of hypovolaemia, with avoidance of iatrogenic fluid overload, recently recognised as a significant cause of mortality in AKI. Rapid sepsis therapy. Urgent relief of urinary tract obstruction.

Cessation of all potentially nephrotoxic drugs.

A rapid followup at discharge in an AKI clinic for survivors of stage 3 AKI, within 7 days of discharge for those in hospital, or within 7 days of the Alert for those not admitted to hospital.

Patients with AKI in the Intervention arm will receive information on preventing AKI during the study.

Good standard care will be provided for all patients in non Experimental arms; clinicians will continue to be able to rapidly refer patients for Nephrology advice or review; online guidance will be available for all clinicians and noted in the alerts for all cases of AKI.