Impact of Electronic Acute Kidney Injury (AKI) Alerts With Automated Nephrologist Consultation on Detection and Severity of AKI: A Quality Improvement Study

Sehoon Park, Seon Ha Baek, Soyeon Ahn, Kee Hyuk Lee, Hee Hwang, Jiwon Ryu, Shin Young Ahn, Ho Jun Chin, Ki Young Na, Dong Wan Chae, Sejoong Kim

    Research output: Contribution to journalArticlepeer-review

    87 Citations (Scopus)

    Abstract

    Background Several electronic alert systems for acute kidney injury (AKI) have been introduced. However, their clinical benefits require further investigation. Study Design Before-and-after quality improvement study. Setting & Participants A tertiary teaching hospital in Korea, which adopted an AKI alert system on June 1, 2014. Before and after launch of the alert system, 1,884 and 1,309 patients with AKI were included in the usual-care and alert groups, respectively. Quality Improvement Plan Implementation of an AKI alert system through which clinicians could generate automated consultations to the nephrology division for all hospitalized patients. Outcomes Primary outcomes included overlooked AKI events, defined as not measuring the follow-up creatinine value, and the consultation pattern of clinicians. Secondary outcomes were severe AKI events; AKI recovery, defined based on the creatinine-based criterion; and patient mortality. Measurements ORs for events of overlooked AKI, early consultation, and severe AKI were calculated with logistic regression. AKI recovery rate and patient mortality were assessed using Cox regression. Results After introduction of the alert system, the odds of overlooked AKI events were significantly lower (adjusted OR, 0.40; 95% CI, 0.30-0.52), and the odds of an early consultation with a nephrologist were greater (adjusted OR, 6.13; 95% CI, 4.80-7.82). The odds of a severe AKI event was reduced after implementation of the alerts (adjusted OR, 0.75; 95% CI, 0.64-0.89). Furthermore, the likelihood of AKI recovery was improved in the alert group (adjusted HR, 1.70; 95% CI, 1.53-1.88). Mortality was not affected by the AKI alert system (adjusted HR, 1.07; 95% CI, 0.68-1.68). Limitations Possible unreported differences between the alert and usual-care groups. Conclusions Implementation of the AKI alert system was associated with beneficial effects in terms of an improved rate of recovery from AKI. Therefore, widespread adoption of such systems could be considered in general hospitals.

    Original languageEnglish
    Pages (from-to)9-19
    Number of pages11
    JournalAmerican Journal of Kidney Diseases
    Volume71
    Issue number1
    DOIs
    Publication statusPublished - 2018 Jan

    Bibliographical note

    Funding Information:
    Support: This study was supported by a Young Investigator Research Grant (number 06-2014-151) from the Korean Society of Nephrology (Kyowa Hakko Kirin 2014), a grant from the Seoul National University Bundang Hospital Research Fund (number 02-2014-058), and a grant from the Korea Research Fund from Ministry of Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea (number HI16C2221). The sponsors of this study played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

    Publisher Copyright:
    © 2017 National Kidney Foundation, Inc.

    Keywords

    • AKI alarm
    • AKI alert
    • Acute kidney injury (AKI)
    • electronic alert
    • electronic medical record (EMR)
    • nephrology consultation
    • quality improvement report
    • serum creatinine

    ASJC Scopus subject areas

    • Nephrology

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