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AKI Alerts

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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
Kianoush Kashani, Claudio Ronco
Acute kidney injury (AKI) is a common complication of acute illnesses with significant impact on the mortality and morbidity. Early recognition of AKI allows clinicians to provide prophylactic interventions and to improve the outcomes of this deadly syndrome. Growing utilization and capabilities of electronic health records allow AKI risk stratification and early recognition with a potential effect on the processes of care and outcomes. We evaluate the current level of evidence on the impact of the AKI e-alert on the processes of care and outcomes...
October 14, 2016: Blood Purification
Tom Blakeman, Kathryn Griffith, Dan Lasserson, Berenice Lopez, Jung Y Tsang, Stephen Campbell, Charles Tomson
OBJECTIVES: Tackling the harm associated with acute kidney injury (AKI) is a global priority. In England, a national computerised AKI algorithm is being introduced across the National Health Service (NHS) to drive this change. The study sought to maximise its clinical utility and minimise the potential for burden on clinicians and patients in primary care. DESIGN: An appropriateness ratings evaluation using the RAND/UCLA Appropriateness Method. SETTING: Clinical scenarios were developed to test the timeliness in (1) communication of AKI warning stage test results from clinical pathology services to primary care, and (2) primary care clinician response to an AKI warning stage test result...
October 11, 2016: BMJ Open
Jay L Koyner, Richa Adhikari, Dana P Edelson, Matthew M Churpek
BACKGROUND AND OBJECTIVES: Identification of patients at risk for AKI on the general wards before increases in serum creatinine would enable preemptive evaluation and intervention to minimize risk and AKI severity. We developed an AKI risk prediction algorithm using electronic health record data on ward patients (Electronic Signal to Prevent AKI). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: All hospitalized ward patients from November of 2008 to January of 2013 who had serum creatinine measured in five hospitals were included...
September 15, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Olga Laszczyńska, Milton Severo, Ana Azevedo
Patients with acute kidney injury (AKI) are at risk for increased morbidity and mortality. Lack of specific treatment has meant that efforts have focused on early diagnosis and timely treatment. Advanced algorithms for clinical assistance including AKI prediction models have potential to provide accurate risk estimates. In this project, we aim to provide a clinical decision supporting system (CDSS) based on a self-learning predictive model for AKI in patients of an acute care hospital. Data of all in-patient episodes in adults admitted will be analysed using "data mining" techniques to build a prediction model...
2016: Studies in Health Technology and Informatics
Janice Oh, Joshua R Bia, Muhamad Ubaid-Ullah, Jeffrey M Testani, Francis Perry Wilson
BACKGROUND: Clinical decision support systems, including electronic alerts, ideally provide immediate and relevant patient-specific information to improve clinical decision-making. Despite the growing capabilities of such alerts in conjunction with an expanding electronic medical record, there is a paucity of information regarding their perceived usefulness. We surveyed healthcare providers' opinions concerning the practicality and efficacy of a specific text-based automated electronic alert for acute kidney injury (AKI) in a single hospital during a randomized trial of AKI alerts...
August 2016: Clinical Kidney Journal
David G Warnock, T Clark Powell, John P Donnelly, Henry E Wang
UNLABELLED: Hospital-associated acute kidney injury (HA-AKI) is associated with increased inpatient mortality. Our objective was to categorize HA-AKI based on the timing of minimum and peak inpatient serum creatinine (sCr) and describe the association with inpatient mortality. MATERIALS AND METHODS: This study is a retrospective analysis of an administrative data set for adults admitted to a single medical center for over 4 years. Changes and timing of the minimum and peak sCr were used to define HA-AKI categories...
2015: Nephron
Björn Meijers, Bart De Moor, Bart Van Den Bosch
No abstract text is available yet for this article.
June 2, 2016: Nephrology, Dialysis, Transplantation
Helen I McDonald, Catriona Shaw, Sara L Thomas, Kathryn E Mansfield, Laurie A Tomlinson, Dorothea Nitsch
Research regarding chronic kidney disease (CKD) and acute kidney injury (AKI) using routinely collected data presents particular challenges. The availability, consistency, and quality of renal data in electronic health records has changed over time with developments in policy, practice incentives, clinical knowledge, and associated guideline changes. Epidemiologic research may be affected by patchy data resulting in an unrepresentative sample, selection bias, misclassification, and confounding by factors associated with testing for and recognition of reduced kidney function...
June 15, 2016: Kidney International
Stuart L Goldstein, Theresa Mottes, Kendria Simpson, Cynthia Barclay, Stephen Muething, David B Haslam, Eric S Kirkendall
Exposure to nephrotoxic medication is among the most common causes of acute kidney injury (AKI) in hospitalized patients. Here we conducted a prospective quality improvement project implementing a systematic Electronic Health Record screening and decision support process (trigger) in our quaternary pediatric inpatient hospital. Eligible patients were noncritically ill hospitalized children receiving an intravenous aminoglycoside for more than 3 days or more than 3 nephrotoxins simultaneously (exposure) from September 2011 through March 2015...
July 2016: Kidney International
Eric A J Hoste, Kianoush Kashani, Noel Gibney, F Perry Wilson, Claudio Ronco, Stuart L Goldstein, John A Kellum, Sean M Bagshaw
PURPOSE OF THE REVIEW: Among hospitalized patients, acute kidney injury is common and associated with significant morbidity and risk for mortality. The use of electronic health records (EHR) for prediction and detection of this important clinical syndrome has grown in the past decade. The steering committee of the 15(th) Acute Dialysis Quality Initiative (ADQI) conference dedicated a workgroup with the task of identifying elements that may impact the course of events following Acute Kidney Injury (AKI) e-alert...
2016: Canadian Journal of Kidney Health and Disease
Matthew T James, Charles E Hobson, Michael Darmon, Sumit Mohan, Darren Hudson, Stuart L Goldstein, Claudio Ronco, John A Kellum, Sean M Bagshaw
Electronic medical records and clinical information systems are increasingly used in hospitals and can be leveraged to improve recognition and care for acute kidney injury. This Acute Dialysis Quality Initiative (ADQI) workgroup was convened to develop consensus around principles for the design of automated AKI detection systems to produce real-time AKI alerts using electronic systems. AKI alerts were recognized by the workgroup as an opportunity to prompt earlier clinical evaluation, further testing and ultimately intervention, rather than as a diagnostic label...
2016: Canadian Journal of Kidney Health and Disease
Wisit Cheungpasitporn, Kianoush Kashani
Acute kidney injury (AKI) is a serious condition that is associated with an increased risk of death, long hospital stays, and high healthcare costs. The best chance of ameliorating the severity of AKI and improving its outcomes is through early recognition and intervention. Electronic health records (EHRs) have now become an integrated part of medical practice in most clinical settings worldwide. Appropriate use of EHRs potentially improves patient care, while poorly designed EHRs could result in unintended consequences...
2016: Contributions to Nephrology
Nigel S Kanagasundaram, Mark T Bevan, Andrew J Sims, Andrew Heed, David A Price, Neil S Sheerin
BACKGROUND: Although the efficacy of computerized clinical decision support (CCDS) for acute kidney injury (AKI) remains unclear, the wider literature includes examples of limited acceptability and equivocal benefit. Our single-centre study aimed to identify factors promoting or inhibiting use of in-patient AKI CCDS. METHODS: Targeting medical users, CCDS triggered with a serum creatinine rise of ≥25 μmol/L/day and linked to guidance and test ordering. User experience was evaluated through retrospective interviews, conducted and analysed according to Normalization Process Theory...
February 2016: Clinical Kidney Journal
Jamie S Hirsch, Sumit Mohan
Critically ill patients with acute kidney injury requiring renal replacement therapy have a poor prognosis. Despite well-known factors, which contribute to outcomes, including dose delivery, patients frequently miss the target dose and volume removal. One major barrier to effective care of these patients is the traditional dissociation of dialysis device data from other clinical information systems, notably the electronic health record (EHR). This lack of integration and the resulting manual documentation leads to errors and biases in documentation and missed opportunities to intervene in a timely fashion...
2015: Nephron
Kerry L Horne, Nicholas M Selby
PURPOSE OF REVIEW: Efforts to improve outcomes from acute kidney injury (AKI) have focussed on timely diagnosis and effective delivery of basic patient care. Electronic alerts (e-alerts) for AKI have attracted interest as a tool to facilitate this. Initial feasibility has already been demonstrated; this review will discuss recent advances in alert methodology, implementation beyond single centres and reported effect on outcomes. RECENT FINDINGS: On-going descriptions of e-alerts highlight increasing variation in both detection algorithms and alert processes...
December 2015: Current Opinion in Critical Care
Stuart L Goldstein
PURPOSE OF REVIEW: Health information technology advancements have resulted in recent increased sophistication of the electronic health record, whereby patient demographic, physiological, and laboratory data can be extracted real-time and integrated into clinical decision support (CDS). RECENT FINDINGS: The implementation of health information technology advancements into CDS in the renal realm has been focused mainly on assessment of kidney function to guide medication dosing in the setting of reduced function or to reactively detect acute kidney injury (AKI) heralded by an abrupt increase in serum creatinine...
December 2015: Current Opinion in Critical Care
M Prendecki, E Blacker, O Sadeghi-Alavijeh, R Edwards, H Montgomery, S Gillis, M Harber
BACKGROUND: Acute kidney injury (AKI) is a significant cause of morbidity and mortality. Early identification may improve the outcome and in 2012 our hospital introduced an automated AKI alert system for early detection and management of AKI. OBJECTIVES: Using an automated AKI alert system we analysed whether early review and intervention by the Critical Care and Outreach (CCOT) team improved patient outcomes in AKI and whether serum bicarbonate was useful in predicting outcomes in patients with AKI...
January 2016: Postgraduate Medical Journal
Samuel A Silver, Stuart L Goldstein, Ziv Harel, Andrea Harvey, Elizabeth J Rompies, Neill K Adhikari, Rey Acedillo, Arsh K Jain, Robert Richardson, Christopher T Chan, Glenn M Chertow, Chaim M Bell, Ron Wald
PURPOSE OF REVIEW: Acute kidney injury (AKI) is an increasingly common problem among hospitalized patients. Patients who survive an AKI-associated hospitalization are at higher risk of de novo and worsening chronic kidney disease, end-stage kidney disease, cardiovascular disease, and death. For hospitalized patients with dialysis-requiring AKI, outpatient follow-up with a nephrologist within 90 days of hospital discharge has been associated with enhanced survival. However, most patients who survive an AKI episode do not receive any follow-up nephrology care...
2015: Canadian Journal of Kidney Health and Disease
Jennifer Joslin, Hannah Wilson, Daniel Zubli, Nathan Gauge, Mark Kinirons, Adrian Hopper, Taryn Pile, Marlies Ostermann
Acute kidney injury (AKI) is common in hospitalised patients but is known be suboptimally managed; the National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) report in 2009 identified significant failings in AKI care. An audit, using standards suggested by the NCEPOD report, of all adult inpatients with AKI in a large central-London NHS hospital in a 7-day period in 2011 showed poor recognition and management of AKI. In response, an AKI 'care bundle' was developed and deployed throughout the hospital along with a programme of enhanced education...
October 2015: Clinical Medicine: Journal of the Royal College of Physicians of London
Kianoush Kashani, Vitaly Herasevich
Electronic health records (EHRs) have become an integrated part of medical practice in most clinical settings around the world. Appropriate use of EHR potentially improves patient care while poorly designed EHR can cause harm. In recent years, EHR has been used as a platform to identify patients who have or may develop acute kidney injury (AKI). The benefit of using EHR for a rule-based classification of AKI has been controversial. While some reports indicate improvement in the process of care provided to AKI patients, other studies do not show significant changes in the outcomes...
2015: Nephron
2015-11-08 08:41:04
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