The impact of the NHS electronic-alert system on the recognition and management of acute kidney injury in acute medicine

Abstract

To address inconsistencies in the recognition and management of acute kidney injury (AKI), an electronic-alert (e-alert) system was implemented by NHS England in 2015. This study aimed to describe its impact within acute medicine in the West Midlands. All admissions to included acute medical units were screened for AKI in two phases, before and after the e-alert was introduced. Data describing recognition and management of patients with AKI were collected. In the 10 units that participated in both phases, recognition of AKI by clinicians signifi cantly improved from 67.9% in 2015 to 76.1% in 2016 (p=0.04). Further analysis of the data found that the presence of an e-alert had a limited effect on recognition and management, suggesting it was not the primary cause of the improvements. Multiple avenues of research have been recommended to clarify the impact of the e-alert system and to improve defi ciencies in management that were identifi ed in the data.

A scoping review exploring the impact of digital systems on processes and outcomes in the care management of acute kidney injury and progress towards establishing learning healthcare systems

“…Thirty-two studies featured an intervention at the micro (individual patient) level. In 15 the main purpose of the intervention was harm prevention,[13,17,19,21,22,26,28,32,35–39] in 12 it was earlier diagnosis,[14,20,24,25,30,31,40–45] and in two, risk prediction. [12,46] Harm prevention interventions involved alerts to clinicians of the need to change nephrotoxic drugs (non-prescription, dose altering or drug suspension) based on a patient’s renal function.…”

“…Interventions at this level were based on real-time data apart from four studies, which used near real-time data. [21,24,40,44] Three quarters of these interventions used interruptive alerts,[13,21,38,43–46] and in a third the alert was outside the clinicians’ workflow. [21,25,30,31,35,40,44,45] All early diagnosis alerts, apart from one (urine output [25]), were activated by changes in serum creatinine (SCr) levels.…”

“…In almost half the interventions where it was specified, the alert was targeted at a physician,[14,19,24–26,28,32,35,37,39–41] with a member of the multidisciplinary team (MDT) being the next most common target. [12,13,17,21,30,31,38,44,46] The digital maturity of the interventions clustered at level 2 (standalone databases not fully integrated into the EHR)[19,22,25,26,28,30,31,35,37,39,41,45] and level 4[12,14,17,20,32,36,42,43,46], two were at level 1[40,44] and four at level 3. [13,21,24,38]…”

Electronic alerts for acute kidney injury across primary and secondary care

“…[8][9][10] Subsequent publications have generated mixed results on the efficacy of AKI alerts on patient outcomes. [11][12][13][14]…”

Scoping review exploring the impact of digital systems on processes and outcomes in the care management of acute kidney injury and progress towards establishing learning healthcare systems

“…13 47 In almost half the interventions where it was specified, the alert was targeted at a physician, 16 20 21 26-28 30 35 39 41-43 with a member of the multidisciplinary team (MDT) being the next most common target. 13 15 19 23 33 34 40 46 47 The digital maturity of the interventions clustered at level 2 (standalone databases not fully integrated into the EHR) 20 21 24 27 28 30 32-34 39 41 43 and level 4, 13 16 19 22 35 38 44 45 47 two were at level 1 42 46 and four at level 3. 15 23 26 40 Meso level Fourteen interventions were found at meso (management) level.…”