Acceptance of Acute Kidney Injury Alert by Providers in Cardiac Surgery Intensive Care Unit

Abstract

Background: Acute Kidney Injury (AKI) is a common complication after cardiac surgery and is associated with worse outcomes. Its management relies on early diagnosis, and therefore, electronic alerts have been used to alert clinicians for development of AKI. Electronic alerts are, however, associated with high rates of alert fatigue. Objectives: We designed this study to assess the acceptance of user-centered electronic AKI alert by clinicians. Methods: We developed a user-centered electronic AKI alert, that provided alerted clinicians of development of AKI in a persistent yet non-interruptive fashion. As the goal of the alert was to alert towards new or worsening AKI, it disappeared 48 hours after being activated. We assessed the acceptance of the alert using surveys at 6 months and 12 months after the alert went live. Results: At 6 months after their implementation 38.9% providers reported that they would not have recognized AKI as early as they did without this alert. This number increased to 66.7% by 12 month survey. Most providers also shared that they re-dosed or discontinued medications earlier, provided earlier management of volume status, avoided IV contrast use and evaluated patients by using point of care ultrasounds more due to the alert. Overall, 83.3% respondents reported satisfaction with the electronic AKI alerts at 6 months and 94.4% at 12 months. Conclusions: This study showed high rates of acceptance of a user-centered electronic AKI alert over time by clinicians taking of patients with AKI.

Clinical Informatics in Critical Care Medicine

“…This area is thus gaining increasing attention in Clinical Informatics. Non-interruptive alerts, that stay at a strategically visible location in a patient’s chart and alert clinicians without disrupting their workflow are a potential alternative to this shortcoming of interruptive alerts [ 10 ], but require further research.…”

“…It is recommended to build CDSS using the five core principles or the five rights of CDSS, as they are called [ 58 ] ( Table 1 ). By following these five rights we were recently able to develop an electronic alert for AKI detection that showed over 83% acceptance rates by end users 6 months after implementation and over 94% acceptance rates 12 months after implementation [ 10 ]. More studies are needed, however, in this area.…”

“…This task is achieved by Clinical Informatics, a specialty that focuses on the development of processes and tools for not only acquisition, processing, and interpretation of patient data but also the design, implementation, and evaluation of information and communication systems to improve patient care. Over the past two decades, a natural alliance between Critical Care Medicine and Clinical Informatics has developed due to the abundance of available data in the intensive care units (ICUs) [7][8][9][10]. In this review we will discuss the evolving role of Clinical Informatics in Critical Care Medicine.…”