Value of electronic alerts for acute kidney injury in high-risk wards: a pilot randomized controlled trial

Abstract

PurposeTo investigate the application value of “electronic alerts” (“e-alerts”) for acute kidney injury (AKI) among high-risk wards of hospitals.MethodsA prospective, randomized, controlled study was conducted. We developed an e-alert system for AKI and ran the system in intensive care units and divisions focusing on cardiovascular disease. The e-alert system diagnosed AKI automatically based on serum creatinine levels. Patients were assigned randomly to an e-alert group (467 patients) or non-e-alert group (408 patients). Only the e-alert group could receive pop-up messages.ResultsThe sensitivity, specificity, Youden Index and accuracy of the AKI e-alert system were 99.8, 97.7, 97.5 and 98.1%, respectively. The prevalence of the diagnosis for AKI and expanded-AKI (AKI or multiple-organ failure) in the e-alert group was higher than that in the non-e-alert group (AKI 7.9 and 2.7%, P = 0.001; expanded-AKI 16.3 and 6.1%, P < 0.001). The prevalence of nephrology consultation in the e-alert group was higher than that in the non-e-alert group (9.0 and 3.7%, P = 0.001). There was no significant difference in the prevalence dialysis, rehabilitation of renal function or death in the two groups.ConclusionThe e-alert system described here was a reliable tool to make an accurate diagnosis of AKI.

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

“…[13–19] The majority of studies were from the US and the UK, with 11 from other countries. [14,18,20–28] Most studies were conducted in hospitals with one in primary care,[29] and one involving community pharmacy services. [22] There were eight randomised controlled trials.…”

“…[22] There were eight randomised controlled trials. [12,20,29–34] The other studies used a range of observational designs, with the majority being uncontrolled before and after studies.…”

“…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.…”

Evaluation of a digitally-enabled care pathway for acute kidney injury management in hospital emergency admissions

“…A small randomised study in China demonstrated that e-alerting alone increased AKI recognition and specialist nephrology review when applied to intensive care and specialist cardiovascular units. 20 That this might improve outcomes is supported by a Korean study, which reported the impacts of an e-alert system which facilitated nephrology consultation, comparing data from implementation to historical controls in the same site. AKI detection improved, nephrology consultations within 3 days increased, and the odds of an AKI 2 or 3 event were reduced and of AKI recovery increased.…”

Opportunities in the cloud or pie in the sky? Current status and future perspectives of telemedicine in nephrology

“…Despite a significant reduction in the number of unrecognized AKI episodes and time to recognition within the emergency department, there were no differences in renal recovery [ 124 ]. Other e-alert systems have also shown variable results, with no improvement in clinical outcomes in AKI seen in the USA (alerts via text message) [ 125 ], improved diagnosis and nephrologist review but limited translated clinical effects in China (e-alerts to physician workstation) [ 126 ] and Korea (automated nephrologist consultation generated) [ 127 ], and numerous improved clinical outcomes in the UK [ 128 ]. We speculate that within the next decade most hospitals in the developed world will have some form of AKI alert system and that the nephrologists of the future and their teams will spend more time assessing patients highlighted in this way.…”