The impact of automated eGFR reporting and education on nephrology service referrals

Noble, E, Johnson, DW, Gray, N, Hollett, P, Hawley, CM, Campbell, SB, Mudge, DW and Isbel, NM (2008) The impact of automated eGFR reporting and education on nephrology service referrals. Nephrology, Dialysis, Transplantation, 23 12: 3845-3850. doi:10.1093/ndt/gfn385

Author Noble, E
Johnson, DW
Gray, N
Hollett, P
Hawley, CM
Campbell, SB
Mudge, DW
Isbel, NM
Title The impact of automated eGFR reporting and education on nephrology service referrals
Journal name Nephrology, Dialysis, Transplantation   Check publisher's open access policy
ISSN 0931-0509
Publication date 2008-01-01
Year available 2008
Sub-type Article (original research)
DOI 10.1093/ndt/gfn385
Open Access Status DOI
Volume 23
Issue 12
Start page 3845
End page 3850
Total pages 6
Place of publication UK
Publisher Oxford University Press
Language eng
Subject 920199 Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified
110312 Nephrology and Urology
Abstract Background. Serum creatinine concentration is an unreliable and insensitive marker of chronic kidney disease (CKD). To improve CKD detection, the Australasian Creatinine Consensus Working Committee recommended reporting of estimated glomerular filtration rate (eGFR) using the four-variable Modification of Diet in Renal Disease (MDRD) formula with every request for serum creatinine concentration. The aim of this study was to evaluate the impact of automated laboratory reporting of eGFR on the quantity and quality of referrals to nephrology services in Southeast Queensland, Australia. Methods. Outpatient referrals to a tertiary and regional renal service, and a single private practice were prospectively audited over 3-12 months prior to and 12 months following the introduction of automated eGFR reporting and concomitant clinician education. The appropriateness of referrals to a nephrologist was assessed according to the Kidney Check Australia Taskforce (KCAT) criteria. Significant changes in the quantity and/or quality of referrals over time were analysed by exponentially weighed moving average (EWMA) charts with control limits based on ±3 standard deviations. Results. A total of 1019 patients were referred to the centres during the study period. Monthly referrals overall increased by 40% following the introduction of eGFR reporting, and this was most marked for the tertiary renal service (52% above baseline). The appropriateness of nephrologist referrals, as adjudicated by the KCAT criteria, fell significantly from 74.3% in the 3 months pre-eGFR reporting to 65.2% in the 12 months thereafter (P < 0.05). Nevertheless, a greater absolute number of CKD patients were appropriately being referred for nephrologist review in the post-eGFR period (24 versus 15 per month). Patients referred following the introduction of eGFR were significantly more likely to be older (median 63.2 versus 59.3 years, P < 0.05), diabetic (25 versus 18%, P = 0.05) and have stage 3 CKD (48% versus 36%, P < 0.01). Conclusion. The introduction of automated eGFR calculation has led to an overall increase in referrals with a small but significant decrease in referral quality. The increase in referrals was seen predominantly in older and diabetic patients with stage 3 CKD and appeared to result in net benefit.
Keyword Transplantation
Urology & Nephrology
Urology & Nephrology
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2009 Higher Education Research Data Collection
School of Medicine Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 49 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 56 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Fri, 20 Mar 2009, 01:30:03 EST by Denise Wilson on behalf of School of Medicine