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Kidney Week

Abstract: FR-PO063

Prevention of AKI in a Tertiary Pediatric Hospital by Real Time Risk Surveillance and Curated Alerts

Session Information

  • AKI Clinical: Predictors
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Vats, Abhay N., Phoenix Children's Hospital, Phoenix, Arizona, United States
  • Sharma, Sheena, Phoenix Children's Hospital, Phoenix, Arizona, United States
  • Iorember, Franca M, Phoenix Children's Hospital, Phoenix, Arizona, United States
  • Turman, Martin A., Phoenix Children's Hospital, Phoenix, Arizona, United States
  • Wold, Brittany, Phoenix Children's Hospital, Phoenix, Arizona, United States
  • Loya, Melinda, Phoenix Children's Hospital, Phoenix, Arizona, United States
  • Farhoudi, Nina, Phoenix Children's Hospital, Phoenix, Arizona, United States
  • Carpentieri, David F, Phoenix Children's Hospital, Phoenix, Arizona, United States
  • Librizzi, Jamie, Phoenix Children's Hospital, Phoenix, Arizona, United States
  • Vaidya, Vinay, Phoenix Children's Hospital, Phoenix, Arizona, United States
  • Kher, Kanwal K., Phoenix Children's Hospital, Phoenix, Arizona, United States
Background

Hospital acquired acute kidney injury (HA-AKI) can significantly increase morbidity, mortality and health care costs in children. We developed a novel electronic health record (EHR) based real-time surveillance system for AKI detection & generation of curated alerts.

Methods

A software designed to provide enterprise-wide data analysis based on algorithms utilizing AKIN criteria for staging was developed. It queries EHR every 6 hours for AKI risks including: baseline serum creatinine (SC), % change, rate of rise in SC, nephrotoxic medications (NTM), therapeutic drug levels (TDM), and renal replacement therapy /nephrology intervention. Quick links to the patient charts are available. The analytic output is automated and made available on a self-updating dashboard which is utilized to generate curated alerts by the enterprise nephrologists.

Results

The dashboard (Fig) generates color coded signals for stage I to III AKI, plots weekly change in SC, NTM exposure , TDM listing, day(s) since last SC & documented nephrology intervention. It detects both NTM & non NTM associated AKI & risk factors. It is even programmed to detect AKI where the absolute SC is <0.5 mg/dl. An AKI surveillance team (pharmacist & nephrologist) reviews the dashboard daily to direct AKI prevention and treatment strategies through curated alerts to the responsible healthcare providers through “two way” integrated Vocera® secure messaging system. This avoids “alert fatigue” and has led to a proactive change in provider’s approach to HA-AKI prevention. The dashboard access progressively increased from 45% to 87% over a short period of 6 weeks.

Conclusion

This novel EHR dashboard and AKI alert system serves as an early warning tool for enterprise wide application. The alerts are traceable, auditable & are HIPAA compliant. AKI biomarkers will be incorporated in the dashboard in near future.This tool allows the HA-AKI prevention team to track at risk patients, provide early detection & prevention of HA-AKI.

AKI Dashboard Screen Shot