Figure 1.

ACT workflow.

Note. The AKI in Care Transitions (ACT) workflow was rolled out in 3 distinct phases separated by time. Phase 1 involved development of an electronic health record indicator of AKI. Phase 2 involved phase 1 + a nephrology nurse liaison education visit prior to dismissal. Phase 3 involved phases 1 and 2 + prepared dismissal orders and follow-up in the outpatient setting. Patients with abnormal serum creatinine or estimated glomerular filtration rate (eGFR) at follow-up were recommended to have a repeat assessment within 3 months. In cases where the postdischarge urinalysis with microscopy revealed an elevated protein osmolality ratio or hematuria, a repeat assessment and urine albumin-to-creatinine ratio were recommended within 3 months. Nephrology referral for follow-up in the outpatient setting was not protocolized and could occur for any patient at any time during the hospitalization or at the direction of the patient’s PCP (as demarcated by the dashed arrows). Follow-up after the immediate PCP transition of care visit coordinated through ACT was nonprotocolized. AKI = acute kidney injury; EHR = electronic health record; SCr = serum creatinine; UA = urinalysis; PCP = primary care provider; KAMPS = kidney follow-up framework (see also Table S3). ⁸