The impact of e-alerts on inpatient diagnosis and management of acute kidney injury.

AIMS/BACKGROUND: Electronic alerts can help with the early detection of acute kidney injury in hospitalised patients. Evidence for their role in improving patient care is limited. The authors have completed an audit loop to evaluate the impact of electronic alerts, and an associated acute kidney injury management pathway, on patient care.

METHODS: The audits were conducted at a large tertiary care hospital in the UK. Case notes were reviewed for 99 patients over two periods: pre-alert (in 2013; n =55) and post-alert (in 2018; n =44), using the same methodology. Patients for case note reviews were randomly chosen from the list of acute kidney injury alerts generated by the local laboratory information management system.

RESULTS: Recognition of acute kidney injury, as documented in the case notes, increased from 15% to 43% between the two periods. Time to first medical review (following electronic alerts) improved by 17 minutes (median 4 hours 4 minutes in 2013 vs 3 hours 47 minutes in 2018). Completion of pre-defined acute kidney injury assessment tasks (review of vital signs, biochemistry and acid-base parameters, evidence of fluid balance assessment, consideration of possible sepsis, and examination or requesting urinalysis) improved in 2018. However, acute kidney injury management tasks (correction of hypovolaemia, addressing or investigating obstruction, medications review, renal referral, requesting of further biochemical tests, addressing possible sepsis) showed very little or no improvement.

CONCLUSIONS: The introduction of acute kidney injury electronic alerts and management pathway resulted in improved recognition and initial assessment of patients with acute kidney injury. Further steps are needed to translate this in to improved patient management.