Automated/integrated real-time clinical decision support in acute kidney injury

Goldstein, Stuart L.

doi:10.1097/mcc.0000000000000250

Cited by 20 publications

(7 citation statements)

References 21 publications

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“…As AKI may have multiple causes, partly from the use of nephrotoxic drugs, we cannot rule out whether this finding is relevant to our study. It may be suggested that the ’sole reliance on electronic health record generated alerts without active healthcare team integration and assessment represents a major barrier to the realisation of the potential of CDS to improve healthcare quality and outcomes’ 29. As we did not assess AKI severity, it is not possible for us to determine whether or not severe AKI decreased.…”

Section: Discussionmentioning

confidence: 97%

Improvement of drug prescribing in acute kidney injury with a nephrotoxic drug alert system

et al. 2017

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ObjectiveElectronic alert systems have shown their capacity for improving the detection of acute kidney injury (AKI). The aim of this study was to design and implement a clinical decision support system (CDSS) for improving drug selection and reducing nephrotoxic drug use in patients with AKI.MethodsThe study was designed as an intervention study comparing a pre and post cohort of patients admitted during April 2014 and April 2015, respectively (phase I and phase II). The intervention was a CDSS which provided kidney function and nephrotoxic drug information. Furthermore, an interruptive alert was designed to detect patients suffering an AKI event while taking a nephrotoxic drug and to see if the dose was then reduced or the drug was discontinued by the physicians.ResultsOne-third of the inpatients were included in the analysis because they met the inclusion criteria (1004 and 1002 patients in phases I and II, respectively). 735 and 761 of them received at least one nephrotoxic alert (73% vs 76%; p=0.763). 65 and 88 patients suffered AKI during admission (6.5% vs 8.8%; p=0.051). In phase I, patients received 384 nephrotoxic alerts (55%) with 78 (20%) of them provoking a change or discontinuation of the nephrotoxic drug. In phase II this value increased to 154 out of 526 (29%) after implementation of the CDSS (p<0.01).ConclusionsA CDSS with interruptive alerts that inform of the development of AKI in real time in patients with nephrotoxic drug prescription has a positive impact on the judicious use of these drugs.

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Section: Discussionmentioning

confidence: 97%

Improvement of drug prescribing in acute kidney injury with a nephrotoxic drug alert system

et al. 2017

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“…3,13 Second, alert fatigue is avoided by consolidating daily alerts into a single report for morning rounds. 18,25,26 Third, there is an educational focus on provider behavioral change in conjunction with implementing the daily AKI alerts. 9,27,28 Fourth, clinical documentation compliance is promoted by partnering with CDI professionals.…”

Section: Discussionmentioning

confidence: 99%

“…Besides standardizing early AKI detection, we aimed to reduce variability in diagnosis by embedding this alerting system into daily clinical workflow. 18,19 The laboratory-triggered AKI alert was distributed in a patient-specific fashion to all inpatient units, with the requirement that such patients be evaluated promptly. Clinical documentation of AKI, through the International Classification of Diseases ( ICD ) coding system, was used as the primary end point and laboratory estimates of AKI severity were assessed as secondary end points to evaluate the effectiveness of daily laboratory alerting.…”

Section: Introductionmentioning

confidence: 99%

Impact of Daily Electronic Laboratory Alerting on Early Detection and Clinical Documentation of Acute Kidney Injury in Hospital Settings

et al. 2018

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Acute kidney injury, especially early-stage disease, is a common hospital comorbidity requiring timely recognition and treatment. We investigated the effect of daily laboratory alerting of patients at risk for acute kidney injury as measured by documented International Classification of Diseases diagnoses. A quasi-experimental study was conducted at 8 New York hospitals between January 1, 2014, and June 30, 2017. Education of clinical documentation improvement specialists, physicians, and nurses was conducted from July 1, 2014, to December 31, 2014, prior to initiating daily hospital-wide laboratory acute kidney injury alerting on January 1, 2015. Incidence based on documented International Classification of Diseases diagnosis of acute kidney injury and acute tubular necrosis during the intervention periods (3 periods of 6 months each: January 1 to June 30 of 2015, 2016, and 2017) were compared to one preintervention period (January 1, 2014, to June 30, 2014). The sample consisted of 269 607 adult hospital discharges, among which there were 39 071 episodes based on laboratory estimates and 27 660 episodes of documented International Classification of Diseases diagnoses of acute kidney injury or acute tubular necrosis. Documented incidence improved significantly from the 2014 preintervention period (5.70%; 95% confidence interval: 5.52%-5.88%) to intervention periods in 2015 (9.89%; 95% confidence interval, 9.66%-10.12%; risk ratio = 1.73, P < .001), 2016 (12.76%; 95% confidence interval, 12.51%-13.01%; risk ratio = 2.24, P < .001), and 2017 (12.49%; 95% confidence interval, 12.24%-12.74%; risk ratio = 2.19, P < .001). A multifactorial intervention comprising daily laboratory alerting and education of physicians, nurses, and clinical documentation improvement specialists led to increased recognition and clinical documentation of acute kidney injury.

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“…However, the literature suggests that alerting practitioners alone, does not improve patient outcomes (14). A systematic integration of clinical decision support with the alert is necessary to influence patient outcomes (15). The ideal AKI QI initiative aimed at recognition involves detected AKI, followed by an alert to the appropriate personnel and recommends intervention of preventative and therapeutic measures.…”

Section: Quality Improvement In Aki Recognition (Early)/response/riskmentioning

confidence: 99%

Does Your Program Know Its AKI and CRRT Epidemiology? The Case for a Dashboard

Mottes

2020

Front. Pediatr.

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Current acute kidney injury (AKI) literature focuses on diagnosis, treatment, and outcomes. While little literature exists studying the quality of care delivered to patients with AKI. However, improving outcomes for patients is dependent on the specifics of the delivered care (i.e., the who, what, when, and how). Therefore, it is necessary to direct attention to process measures to assess the relationship between care and outcomes. The application of quality improvement science to the care of AKI, uses a series of metrics encompassing both processes and outcomes to better understand, evaluate, and ensure the delivery high quality care.

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Automated/integrated real-time clinical decision support in acute kidney injury

Cited by 20 publications

References 21 publications

Improvement of drug prescribing in acute kidney injury with a nephrotoxic drug alert system

Improvement of drug prescribing in acute kidney injury with a nephrotoxic drug alert system

Impact of Daily Electronic Laboratory Alerting on Early Detection and Clinical Documentation of Acute Kidney Injury in Hospital Settings

Does Your Program Know Its AKI and CRRT Epidemiology? The Case for a Dashboard

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