Background: Acute kidney injury (AKI) is an abrupt decrease in kidney function associated with significant morbidity and mortality. Electronic notifications of AKI have been utilized in hospitalized patients, but their efficacy in the outpatient setting is unclear. Methods: We evaluated the impact of two outpatient interventions: an automated comment on increasing creatinine results (intervention I; 6 months; n=159) along with an email to the provider (intervention II; 3 months; n=105) compared to a control (baseline; 6 months; n=176). A comment was generated if a patient's creatinine increased by >0.5 mg/dL (previous creatinine ≤2.0 mg/dL) or by 50% (previous creatinine >2.0 mg/dL) within 180 days. Process measures included documentation of AKI and clinical actions. Clinical outcomes were defined as recovery from AKI within 7 days, prolonged AKI from 8 to 89 days, progression to CKD within 120 days. Results: Providers were more likely to document AKI in interventions I (p=0.004; OR=2.80) and II (p=0.01; OR=2.66). Providers were also more likely to discontinue nephrotoxins in intervention II (p<0.001; OR= 4.88). The median time to follow-up creatinine trended shorter among patients with AKI documented (21 vs. 42 days; p=0.11). There were no significant differences in clinical outcomes. Conclusions: An automated comment was associated with improved documented recognition of AKI and the additive intervention of an email alert was associated with increased discontinuation of nephrotoxins, but neither improved clinical outcomes. Translation of these findings into improved outcomes may require corresponding standardization of clinical practice protocols for managing AKI.
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