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Kidney Week

Abstract: SA-PO543

Integrating Electronic Alerts and Clinical Decision Support Systems to Improve Diagnosis and Management of AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Menon, Shina, Seattle Children's Hospital, Seattle, Washington, United States
  • Wu, Hong, Seattle Children's Hospital, Seattle, Washington, United States
  • Tarrago, Rod, Seattle Children's Hospital, Seattle, Washington, United States
  • Yonekawa, Karyn, Seattle Children's Hospital, Seattle, Washington, United States
Background

Acute kidney injury(AKI) is a common clinical event with severe consequences. It is associated with prolonged hospital stay, increased risk of mortality and progression to chronic kidney disease. It is often underrecognized and underdiagnosed as seen in studies with significant discrepancy in incidence based on methods (administrative data vs chart review). Early, accurate diagnosis and correct management can improve the standard of care and patient outcomes

Methods

This is preliminary data from an ongoing prospective intervention study across all non-nephrology, non-intensive care patients (6 mo-18yrs) at Seattle Children’s Hospital.Our aim was to see if an electronic-alert (e-alert) combined with a clinical decision support system (CDSS) can improve detection and outcome of AKI. We developed an automated real-time e-alert using Kidney Disease Improving Global Outcomes (KDIGO) criteria. E-Alert with stage of AKI was sent as a text page to the contact provider in a patient's electronic health record. It was linked to a CDSS providing basic guidelines on AKI management. The CDSS did not place orders or consults automatically.

Results

83 AKI alerts were recorded across both phases(Table). Both groups had similar baseline characteristics including age, admitting service, history of transplant or past AKI. There was significant difference in the recognition and documentation of AKI (41%, pre-alert phase vs 80%, alert phase, p<0.005). More renal consults were obtained for severe AKI (>KDIGO Stage 2) in the alert phase (86.6% vs 36.3%, p<0.005). A higher proportion of patients in alert phase showed return to a baseline kidney function by discharge. Data on follow up and long term outcome is awaited.

Conclusion

Our study shows that AKI remains under diagnosed. E-alerts improve the recognition of AKI, enabling providers to intervene early. They encourage nephrology consultation for severe AKI. This may improve outcomes of children with AKI

Key differences between the study phases
 Pre-alert phase
(43 episodes in 41 admissions)
E-alert phase
(40 episodes in 38 admissions)
History of transplant, nBMT = 6
Heart = 5
Liver = 0
BMT = 7
Heart = 5
Liver = 1
Previous AKI, n (%)20 (48%)21 (58%)
AKI severity, n (%)Stage 1= 31 (72%)
Stage 2/3= 12 (28%)
Stage 1= 25 (62.5%)
Stage 2/3= 15 (37.5%)
AKI documented, n (%)18 (41.8%)32 (80%)*
Renal consult for AKI Stage 2 or 3, n(%)4 (33.3%)13 (86.6%)*
Return of kidney function to baseline at discharge, n(%)20 (48.7%)23(63.8%)

* p<0.005