UE / ACR

This video explains how the system provides guidance for referrals to nephrology based on risk equations, updates CKD staging, and manages follow-ups. It includes features for clinician review, coding, and initiating medication changes.

Or if you prefer a step-by-step guide:

Step-by-Step Guide: Using the CKD, U&E, and ACR Pathology System for Clinician Review

This guide will help clinicians review and manage patients using the CKD (Chronic Kidney Disease), U&E (Urea & Electrolytes), and ACR (Albumin-Creatinine Ratio) parts of the pathology system.

Step 1: Access the Pathology Template

• Navigate to the pathology template via the toolbar, or press F12 and search for "pathology."
• Select the template that corresponds to the report or test you want to review (e.g., U&E or ACR).

Step 2: Review Pathology Results

• Look for patients whose results are marked as "awaiting clinician review". This flag is used so that both clinicians and admin staff can track patients who are waiting for further review.
• Check for notifications like "consider a referral to nephrology". The system flags patients based on criteria such as the Kidney Failure Risk Equation (KFRE) being greater than 5%.

Step 3: Use the Actionable Codes

• If you see three stars (*),** right-click to access action options. These allow you to directly interact with the system (e.g., updating the patient’s referral status).
• You can also expand for more details, including relevant NICE guidelines.

Step 4: Review Patient Information

• The system shows:
  • CKD coding entries.
  • The latest KFRE value.
  • Other test results that help in deciding the next step.

Step 5: Handle Referrals

• Choose one of the options available based on the patient’s situation:
  • Referral to Nephrology: Select this if referral is needed.
  • Referral Refused: If the patient declines, select this option, and you can add notes (e.g., "discussed with patient, referral declined").
  • Under Nephrology Care: If the patient is already under care, select this option to remove them from the report.

Step 6: Auto-Consult for Referrals

• When you select an option, the system launches an auto consult, which helps you add necessary codes and notes. For example, choosing "referral refused" will add a code and prompt you to enter details about the discussion.

Step 7: Monitor Future Reports

• If the patient’s condition changes, or their test results continue to indicate a need for referral, they will reappear in the reports. This ensures continued follow-up if necessary.

Step 8: Managing Patients Needing Medication (ACE or ARB)

• For patients needing medication based on their results, such as those with ACR > 70, the system will flag them for "initiating an ACE or ARB."
• If contraindications (e.g., allergies) exist, the system will show these. Otherwise, use the dropdowns to add any relevant contraindications.

Step 9: Prescribing Medication

• If you prescribe an ACE or ARB, the system will automatically remove the patient from this list.
• There are links to CKD templates and formularies (such as Ardens CKD Formulary) to assist with decision-making.

Step 10: Finalising the Review

• Ensure that all options (referral, medication, follow-up) are properly recorded to remove the patient from the system’s pending lists.
• If there is additional functionality or information you think should be added to the template, provide feedback for future improvements.

Step 11: Handling Patient Inquiries

• Patients may call to ask about their test results. Make sure to update the patient’s status or referral to provide accurate information when queried.
• This process is designed to streamline patient management, making sure clinicians have the right tools and options at hand for managing CKD and related conditions.