Impact of electronic alerts for acute kidney injury on patient outcomes: interrupted time-series analysis of population cohort data

Abstract

Background Automated acute kidney injury (AKI) electronic alerts (e-alerts) are rule-based warnings triggered by changes in creatinine and are intended to facilitate earlier detection in AKI. We assessed the impact of the introduction in the Tayside region of UK in April 2015 of automated AKI e-alerts with an accompanying education programme. Methods Interrupted time-series analysis using segmented regression was performed involving all adults with AKI aged ≥18 years who had a serum creatinine measured between 1 April 2013 and 31 March 2017. Analysis evaluated associations of AKI e-alert introduction on rate and severity (Stages 2–3) of AKI as well as mortality and occupied hospital bed days per patient per month in the population with AKI. Results There were 32 320 episodes of AKI during the observation period. Implementation of e-alerts had no effect on the rate of any AKI [incidence rate ratio (IRR) 0.996, 95% confidence interval (CI) 0.991 to 1.001, P = 0.086] or on the rate of severe AKI (IRR 0.995, 95% CI 0.990 to 1.000, P = 0.061). Subgroup analysis found no impact on the rate or severity of AKI in hospital or in the community. Thirty-day mortality following AKI did not improve (IRR 0.998, 95% CI 0.987 to 1.009, P = 0.688). There was a slight reduction in occupied bed days (β-coefficient −0.059, 95% CI −0.094 to −0.025, P = 0.002). Conclusions Introduction of automated AKI e-alerts was not associated with a change in the rate, severity or mortality associated with AKI, but there was a small reduction in occupied hospital bed days.

Opportunities in digital health and electronic health records for acute kidney injury care

“…However, the time series study design did not allow changes due to the alerting system to be differentiated those that happened independently. In a similarly designed study from Scotland, the introduction of automated AKI alerts was not associated with change in AKI incidence or severity, nor on mortality, although there was a small reduction in hospital length of stay [28]. This reduction in hospital length of stay has been reported in previous studies [29], including in the multicentre cluster randomized Tackling AKI study in which an AKI alerting system was evaluated as part of a more complex intervention [30].…”

The Computerized Algorithm for Renal Assessment Improves Diagnostic Accuracy of Renal Impairment in Hospitalized Patients

“…Nonetheless, there exist some drawbacks. In an observational cohort study with segmented regression analysis conducted in U.K., the implementation of electronic AKI alert system and AKI-related staff education did not show a reduction in the severity and mortality associated with AKI [12]. In a previous study conducted in Korea, while the implementation of electronic AKI alerts with automated nephrologist consultation improved the likelihood of AKI recovery, the mortality of AKI patients was not affected [13].…”

Automated Electronic Alert for the Care and Outcomes of Adults With Acute Kidney Injury

“…However, 10 nonrandomized clinical trials and 3 randomized clinical trials (RCTs) of the alert system had mixed results. Seven of 10 nonrandomized clinical trials reported improved patient-centered outcomes, including improved AKI recovery, reduced mortality and dialysis rates, and decreased hospital length of stay (LOS) . In contrast, RCT results have suggested that AKI alerts were less beneficial, possibly even causing harm in specific instances .…”

“…Seven of 10 nonrandomized clinical trials reported improved patient-centered outcomes, including improved AKI recovery, 5 , 6 , 7 reduced mortality and dialysis rates, 8 , 9 , 10 and decreased hospital length of stay (LOS). 9 , 11 , 12 In contrast, RCT results have suggested that AKI alerts were less beneficial, possibly even causing harm in specific instances. 13 , 14 , 15 A 2015 trial by Wilson et al 13 showed increased dialysis rates in the surgical ward subgroup.…”