Electronic alerts and a care bundle for acute kidney injury - an Australian cohort study

Nephrol Dial Transplant. 2022 Apr 19;gfac155. doi: 10.1093/ndt/gfac155. Online ahead of print.

Abstract

Background: Early recognition of hospital-acquired Acute Kidney Injury (AKI) may improve patient management and outcomes.

Methods: This multicentre study was conducted at three hospitals (H1-intervention; H2 & H3 -controls) served by a single laboratory. The intervention bundle (an interruptive aAlert showing AKI stage and baseline creatinine in the eMR, a management guide and junior medical staff education) was implemented only at H1. Outcome variables included length of stay (LOS), all-cause in-hospital mortality and management quality.

Results: Over 6 months, 639 patients developed AKI (265 at H1, and 374 at controls), with 94.7% in general wards; 537 (84%) patients developed stage 1, 58 (9%) stage 2 and 43 (7%) stage 3 AKI. Median LOS was 9 days (IQR 4-17) and not different between intervention and controls. However, patients with AKI stage 1 had shorter LOS at H1 (median 8 versus 10 days (p = 0.021). Serum creatinine had risen prior to admission in most patients. Documentation of AKI was better in H1 (94.8% vs 83.4%; p = 0.001), with higher rates of nephrology consultation (25% vs 19%; p = 0.04) and cessation of nephrotoxins (25.3 vs 18.8% p = 0.045). There was no difference in mortality between H1 vs Controls (11.7% vs 13.0%; p = 0.71).

Conclusions: Most hospitalised patients developed stage 1 AKI and developed AKI in the community and remained outside the ICU. The AKI eAlert bundle reduced LOS in most patients with AKI and increased AKI documentation, nephrology consultation rate and cessation of nephrotoxic medications.

Keywords: acute kidney injury; eAlert; hospitalisation; length of stay; mortality.