The marginal effects of acute kidney injury on in-hospital mortality, length of stay (LOS), and costs have not been well described. A consecutive sample of 19,982 adults who were admitted to an urban academic medical center, including 9210 who had two or more serum creatinine (SCr) determinations, was evaluated. The presence and degree of acute kidney injury were assessed using absolute and relative increases from baseline to peak SCr concentration during hospitalization. Large increases in SCr concentration were relatively rare (e.g., >2.0 mg/dl in 105 [1%] patients), whereas more modest increases in SCr were common (e.g., >0.5 mg/dl in 1237 [13%] patients). Modest changes in SCr were significantly associated with mortality, LOS, and costs, even after adjustment for age, gender, admission International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis, severity of illness (diagnosis-related group weight), and chronic kidney disease. For example, an increase in SCr >0.5 mg/dl was associated with a 6.5-fold (95% confidence interval 5.0 to 8.5) increase in the odds of death, a 3.5-d increase in LOS, and nearly $7500 in excess hospital costs. Acute kidney injury is associated with significantly increased mortality, LOS, and costs across a broad spectrum of conditions. Moreover, outcomes are related directly to the severity of acute kidney injury, whether characterized by nominal or percentage changes in serum creatinine. A cute kidney injury (AKI) has been reported in 5 to 7%of hospitalized patients on the basis of several singlecenter reports (1,2). Despite the perception that AKI is relatively common, there is no uniform definition for AKI, and relatively few data regarding its incidence in hospitalized patients are available. Moreover, the relative effects of AKI on mortality, hospital length of stay (LOS), and costs have not been well described. Most studies that have explored downstream effects of AKI have either considered AKI requiring dialysis or homogenous patient populations, such as those who were exposed to radiocontrast agents or undergoing cardiothoracic surgery.In the context of a computer-based intervention in which data were collected on kidney function, severity of illness, drug prescription, and outcomes in hospitalized patients (3), we linked changes in serum creatinine (SCr) with in-hospital mortality, LOS, and costs. We hypothesized that relatively small changes in SCr would be common and associated with adverse outcomes, even after adjustment for severity of disease. Materials and Methods Study SettingThe study was conducted at Brigham and Women's Hospital, a 720-bed urban academic medical center in Boston, MA. Data were obtained for a study to examine the effects of a computer-order entrybased decision tool on drug prescribing for hospitalized patients with impaired kidney function (3). As part of the data library collected for evaluation of the appropriateness of drug prescription, serial SCr determinations were collected on a consecutive series of hospitalized pat...

Few U.S. hospitals have implemented computerized physician order entry (CPOE) in spite of its effectiveness at preventing serious medication errors. We interviewed senior management at twenty-six hospitals to identify ways to overcome barriers to adopting and implementing CPOE. Within the hospital, strong leadership and high-quality technology were critical. Hospitals that placed a high priority on patient safety could more easily justify the cost of CPOE. Outside the hospital, financial incentives and public pressures encouraged CPOE adoption. Dissemination of data standards would accelerate the maturation of vendors and lower CPOE costs. These findings highlight several policy levers to speed the adoption of this important patient safety technology.

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Background: Comprehensive knowledge about the level of healthcare information technology (HIT) adoption in the United States remains limited. We therefore performed a baseline assessment to address this knowledge gap.

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