Sehoon Park1, Seon Ha Baek2, Soyeon Ahn3, Kee-Hyuk Lee4, Hee Hwang5, Jiwon Ryu6, Shin Young Ahn7, Ho Jun Chin8, Ki Young Na8, Dong-Wan Chae8, Sejoong Kim9. 1. Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea. 2. Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, Korea. 3. Medical Research Collaborating Center, Seoul National University Bundang Hospital, Gyeonggi-do, Korea. 4. Department of Family Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea. 5. Department of Pediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, Korea. 6. Department of Internal Medicine, Jeju Halla Hospital, Jeju, Korea. 7. Department of Internal Medicine, Korea University Medical Center Guro Hospital, Seoul, Korea. 8. Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. 9. Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. Electronic address: sejoong2@snu.ac.kr.
Abstract
BACKGROUND: Several electronic alert systems for acute kidney injury (AKI) have been introduced. However, their clinical benefits require further investigation. STUDY DESIGN: Before-and-after quality improvement study. SETTING & PARTICIPANTS: A tertiary teaching hospital in Korea, which adopted an AKI alert system on June 1, 2014. Before and after launch of the alert system, 1,884 and 1,309 patients with AKI were included in the usual-care and alert groups, respectively. QUALITY IMPROVEMENT PLAN: Implementation of an AKI alert system through which clinicians could generate automated consultations to the nephrology division for all hospitalized patients. OUTCOMES: Primary outcomes included overlooked AKI events, defined as not measuring the follow-up creatinine value, and the consultation pattern of clinicians. Secondary outcomes were severe AKI events; AKI recovery, defined based on the creatinine-based criterion; and patient mortality. MEASUREMENTS: ORs for events of overlooked AKI, early consultation, and severe AKI were calculated with logistic regression. AKI recovery rate and patient mortality were assessed using Cox regression. RESULTS: After introduction of the alert system, the odds of overlooked AKI events were significantly lower (adjusted OR, 0.40; 95% CI, 0.30-0.52), and the odds of an early consultation with a nephrologist were greater (adjusted OR, 6.13; 95% CI, 4.80-7.82). The odds of a severe AKI event was reduced after implementation of the alerts (adjusted OR, 0.75; 95% CI, 0.64-0.89). Furthermore, the likelihood of AKI recovery was improved in the alert group (adjusted HR, 1.70; 95% CI, 1.53-1.88). Mortality was not affected by the AKI alert system (adjusted HR, 1.07; 95% CI, 0.68-1.68). LIMITATIONS: Possible unreported differences between the alert and usual-care groups. CONCLUSIONS: Implementation of the AKI alert system was associated with beneficial effects in terms of an improved rate of recovery from AKI. Therefore, widespread adoption of such systems could be considered in general hospitals.
BACKGROUND: Several electronic alert systems for acute kidney injury (AKI) have been introduced. However, their clinical benefits require further investigation. STUDY DESIGN: Before-and-after quality improvement study. SETTING & PARTICIPANTS: A tertiary teaching hospital in Korea, which adopted an AKI alert system on June 1, 2014. Before and after launch of the alert system, 1,884 and 1,309 patients with AKI were included in the usual-care and alert groups, respectively. QUALITY IMPROVEMENT PLAN: Implementation of an AKI alert system through which clinicians could generate automated consultations to the nephrology division for all hospitalized patients. OUTCOMES: Primary outcomes included overlooked AKI events, defined as not measuring the follow-up creatinine value, and the consultation pattern of clinicians. Secondary outcomes were severe AKI events; AKI recovery, defined based on the creatinine-based criterion; and patient mortality. MEASUREMENTS: ORs for events of overlooked AKI, early consultation, and severe AKI were calculated with logistic regression. AKI recovery rate and patient mortality were assessed using Cox regression. RESULTS: After introduction of the alert system, the odds of overlooked AKI events were significantly lower (adjusted OR, 0.40; 95% CI, 0.30-0.52), and the odds of an early consultation with a nephrologist were greater (adjusted OR, 6.13; 95% CI, 4.80-7.82). The odds of a severe AKI event was reduced after implementation of the alerts (adjusted OR, 0.75; 95% CI, 0.64-0.89). Furthermore, the likelihood of AKI recovery was improved in the alert group (adjusted HR, 1.70; 95% CI, 1.53-1.88). Mortality was not affected by the AKI alert system (adjusted HR, 1.07; 95% CI, 0.68-1.68). LIMITATIONS: Possible unreported differences between the alert and usual-care groups. CONCLUSIONS: Implementation of the AKI alert system was associated with beneficial effects in terms of an improved rate of recovery from AKI. Therefore, widespread adoption of such systems could be considered in general hospitals.
Authors: Sehoon Park; Hyunjeong Cho; Seokwoo Park; Soojin Lee; Kwangsoo Kim; Hyung Jin Yoon; Jiwon Park; Yunhee Choi; Suehyun Lee; Ju Han Kim; Sejoong Kim; Ho Jun Chin; Dong Ki Kim; Kwon Wook Joo; Yon Su Kim; Hajeong Lee Journal: J Am Soc Nephrol Date: 2018-12-18 Impact factor: 10.121
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