Electronic Alerts for Acute Kidney Injury

Haase, Michael; Kribben, Andreas; Zidek, Walter; Floege, Jürgen; Albert, Christian; Isermann, Berend; Robra, Bernt‐Peter; Haase-Fielitz, Anja

doi:10.3238/arztebl.2017.0001

Cited by 27 publications

(24 citation statements)

References 41 publications

(109 reference statements)

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“…For this reason, the alerts were limited to serum creatinine values that are more routinely ordered for hospital patients and can be more accurately compared to KDIGO criteria. This alerting function is consistent with many of the previously reported studies due to the challenges in urine output records for identifying AKI [ 8 ]. A novel aspect of our CDS system was the inclusion of guidance to tailor IV fluid therapies based on the assessment of a patient’s risk for volume overload and the incorporation of steps for monitoring the response to IV fluid administration, which may improve the effectiveness and safety of IV fluid administration in clinical care.…”

Section: Discussionsupporting

confidence: 89%

“…Haase et al [ 8 ] conducted a systematic review on electronic alerts for AKI and found variability in effectiveness for clinical outcomes. Our intervention aligns with many aspects of successful interventions, such as the development of AKI alerts that are linked with warnings of potentially harmful medications, links to treatment recommendations, and the non-disruptive function of AKI alerts.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have reported on implementation of AKI alerts in acute care settings. A recent systematic review identified 16 studies that implemented electronic alerts for AKI, including both interruptive and non-disruptive alert systems [ 8 ]. Interruptive alerts are typically pushed to healthcare providers through various modes (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Development and initial implementation of electronic clinical decision supports for recognition and management of hospital-acquired acute kidney injury

Howarth

Bhatt

Benterud

et al. 2020

BMC Med Inform Decis Mak

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Background Acute kidney injury (AKI) is common in hospitalized patients and is associated with poor patient outcomes and high costs of care. The implementation of clinical decision support tools within electronic medical record (EMR) could improve AKI care and outcomes. While clinical decision support tools have the potential to enhance recognition and management of AKI, there is limited description in the literature of how these tools were developed and whether they meet end-user expectations. Methods We developed and evaluated the content, acceptability, and usability of electronic clinical decision support tools for AKI care. Multi-component tools were developed within a hospital EMR (Sunrise Clinical Manager™, Allscripts Healthcare Solutions Inc.) currently deployed in Calgary, Alberta, and included: AKI stage alerts, AKI adverse medication warnings, AKI clinical summary dashboard, and an AKI order set. The clinical decision support was developed for use by multiple healthcare providers at the time and point of care on general medical and surgical units. Functional and usability testing for the alerts and clinical summary dashboard was conducted via in-person evaluation sessions, interviews, and surveys of care providers. Formal user acceptance testing with clinical end-users, including physicians and nursing staff, was conducted to evaluate the AKI order set. Results Considerations for appropriate deployment of both non-disruptive and interruptive functions was important to gain acceptability by clinicians. Functional testing and usability surveys for the alerts and clinical summary dashboard indicated that the tools were operating as desired and 74% (17/23) of surveyed healthcare providers reported that these tools were easy to use and could be learned quickly. Over three-quarters of providers (18/23) reported that they would utilize the tools in their practice. Three-quarters of the participants (13/17) in user acceptance testing agreed that recommendations within the order set were useful. Overall, 88% (15/17) believed that the order set would improve the care and management of AKI patients. Conclusions Development and testing of EMR-based decision support tools for AKI with clinicians led to high acceptance by clinical end-users. Subsequent implementation within clinical environments will require end-user education and engagement in system-level initiatives to use the tools to improve care.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Development and initial implementation of electronic clinical decision supports for recognition and management of hospital-acquired acute kidney injury

Howarth

Bhatt

Benterud

et al. 2020

BMC Med Inform Decis Mak

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“…The efficacy of AKI e-alerts is limited and has not shown consistent benefit8 in terms of reduced mortality or use of renal support, or positive impacts on processes of care,9 which may be the result of alert fatigue5 10 or disrupted workflow 10. Inadequate implementation can explain the poor outcomes, particularly as there are some examples of improved care processes11 and treatment outcomes through successful implementation 12–14. Mandatory incorporation of AKI alerts into all secondary care organisations in England lacked a clear implementation strategy, and recently published systematic reviews recognised large variation in implementation,12 with an association between poor implementation and poor outcome 9.…”

Section: Introductionmentioning

confidence: 99%

“…Inadequate implementation can explain the poor outcomes, particularly as there are some examples of improved care processes11 and treatment outcomes through successful implementation 12–14. Mandatory incorporation of AKI alerts into all secondary care organisations in England lacked a clear implementation strategy, and recently published systematic reviews recognised large variation in implementation,12 with an association between poor implementation and poor outcome 9. One review specifically identified a paucity of research on the implementation of AKI e-alerts internationally 9.…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury electronic alerts: mixed methods Normalisation Process Theory evaluation of their implementation into secondary care in England

et al. 2019

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ObjectiveAround one in five emergency hospital admissions are affected by acute kidney injury (AKI). To address poor quality of care in relation to AKI, electronic alerts (e-alerts) are mandated across primary and secondary care in England and Wales. Evidence of the benefit of AKI e-alerts remains conflicting, with at least some uncertainty explained by poor or unclear implementation. The objective of this study was to identify factors relating to implementation, using Normalisation Process Theory (NPT), which promote or inhibit use of AKI e-alerts in secondary care.DesignMixed methods combining qualitative (observations, semi-structured interviews) and quantitative (survey) methods.Setting and participantsThree secondary care hospitals in North East England, representing two distinct AKI e-alerting systems. Observations (>44 hours) were conducted in Emergency Assessment Units (EAUs). Semi-structured interviews were conducted with clinicians (n=29) from EAUs, vascular or general surgery or care of the elderly. Qualitative data were supplemented by Normalization MeAsure Development (NoMAD) surveys (n=101).AnalysisQualitative data were analysed using the NPT framework, with quantitative data analysed descriptively and using χ2 and Wilcoxon signed-rank test for differences in current and future normalisation.ResultsParticipants reported familiarity with the AKI e-alerts but that the e-alerts would become more normalised in the future (p<0.001). No single NPT mechanism led to current (un)successful implementation of the e-alerts, but analysis of the underlying subconstructs identified several mechanisms indicative of successful normalisation (internalisation, legitimation) or unsuccessful normalisation (initiation, differentiation, skill set workability, systematisation).ConclusionsClinicians recognised the value and importance of AKI e-alerts in their practice, although this was not sufficient for the e-alerts to be routinely engaged with by clinicians. To further normalise the use of AKI e-alerts, there is a need for tailored training on use of the e-alerts and routine feedback to clinicians on the impact that e-alerts have on patient outcomes.

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Behandlung, klinischer Verlauf und sektorenübergreifende Informationsübermittlung bei Patienten mit akut-auf-chronischer Nierenschädigung

Haase-Fielitz

Ernst²,

Lehmanski

et al. 2019

Bundesgesundheitsbl

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Electronic Alerts for Acute Kidney Injury

Cited by 27 publications

References 41 publications

Development and initial implementation of electronic clinical decision supports for recognition and management of hospital-acquired acute kidney injury

Development and initial implementation of electronic clinical decision supports for recognition and management of hospital-acquired acute kidney injury

Acute kidney injury electronic alerts: mixed methods Normalisation Process Theory evaluation of their implementation into secondary care in England

Behandlung, klinischer Verlauf und sektorenübergreifende Informationsübermittlung bei Patienten mit akut-auf-chronischer Nierenschädigung

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