Background Electronic alerts (e-alerts) for Acute Kidney Injury (AKI) have been implemented into a variety of different Electronic Health Records (EHR) systems worldwide in order to improve recognition and encourage early appropriate management of AKI. We were interested in the impact on patient safety, specialist referral and clinical management. Methods All patients admitted to our institution with AKI were included in the study. We studied AKI progression, dialysis dependency, length of hospital stay, emergency readmission, ICU readmission, and death, before and after the introduction of electronic alerts. The impact on prescription of high risk drugs, fluid administration, and referral to renal services was also analysed. Results After the introduction of the e-alert, progression to higher AKI stage, emergency readmission to hospital and death during admission were significantly reduced. More prescriptions were stopped for drugs that adversely affect renal function in AKI and there was a significant increase in the ICU admissions and in the number of patients having dialysis, especially in earlier stages. Longer term mortality, renal referrals, and fluid alteration did not change significantly after the AKI e-alert introduction. Conclusions AKI e-alerts can improve clinical outcomes in hospitalised patients.

The use of indwelling pleural catheters (IPC) is well established in the treatment of malignant pleural effusions. They allow symptom management with intermittent drainage without requiring overnight admission to hospital. However, little is known about their effectiveness in the treatment of pleural infections. Here, we present a case where an IPC is used in the therapeutic management of tuberculous empyema. The IPC enabled outpatient treatment, allowed the patient to return to work and reduced the cost of treatment and the risk of hospital-acquired complications.

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