Altmetric

Improving outcomes in patients with Acute Kidney Injury: the impact of hospital based automated AKI alerts

Title: Improving outcomes in patients with Acute Kidney Injury: the impact of hospital based automated AKI alerts
Authors: Prendecki, M
Blacker, E
Sadeghi-Alavijeh, O
Edwards, R
Montgomery, H
Gillis, S
Harber, M
Item Type: Journal Article
Abstract: 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. Methods In a retrospective analysis we identified patients who triggered an AKI alert from 20 April 2012 to 20 September 2013 and collected data on mortality, length of stay, need for intensive care admission and renal replacement therapy (RRT). Results 994 AKI alerts were generated and analysed. Patients with bicarbonate outside the normal range had significantly higher mortality. Bicarbonate <22 mmol/L was associated with a mortality of 25.7% (49/191) compared with 16.9% (39/231) when 22–29 mmol/L (p=0.047, χ2). Those patients reviewed ≥1 day after AKI alert by CCOT compared with those seen on the day of the alert had a 2.4 times increase in mortality and were 7 times more likely to require RRT acutely. Conclusions Electronically identified AKI alerts identify patients at high risk of morbidity and mortality. In this group AKI alerts preceded CCOT review by a mean of 2 days. This represents a window for supportive interventions, which may explain improved outcomes in those reviewed earlier. The addition of serum bicarbonate offers a further method of risk stratifying patients at greater risk of death.
Issue Date: 16-Dec-2015
Date of Acceptance: 25-Sep-2015
URI: http://hdl.handle.net/10044/1/72105
DOI: http://dx.doi.org/10.1136/postgradmedj-2015-133496
ISSN: 0032-5473
Publisher: BMJ Publishing Group
Start Page: 9
End Page: 13
Journal / Book Title: Postgraduate Medical Journal
Volume: 92
Issue: 1083
Copyright Statement: © 2015. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
ACUTE-RENAL-FAILURE
MORTALITY
DISEASE
Acute Kidney Injury
Adult
Aged
Algorithms
Bicarbonates
Biomarkers
Clinical Alarms
Computer Systems
Early Diagnosis
Female
Hospital Mortality
Hospitalization
Humans
Intensive Care Units
Length of Stay
Male
Middle Aged
Monitoring, Physiologic
Prognosis
Renal Replacement Therapy
Retrospective Studies
Risk Factors
Humans
Bicarbonates
Monitoring, Physiologic
Early Diagnosis
Prognosis
Hospitalization
Length of Stay
Renal Replacement Therapy
Hospital Mortality
Risk Factors
Retrospective Studies
Algorithms
Computer Systems
Adult
Aged
Middle Aged
Intensive Care Units
Female
Male
Clinical Alarms
Acute Kidney Injury
Biomarkers
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
ACUTE-RENAL-FAILURE
MORTALITY
DISEASE
11 Medical and Health Sciences
General & Internal Medicine
Publication Status: Published
Online Publication Date: 2015-10-28
Appears in Collections:Department of Medicine
Faculty of Medicine



Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Creative Commonsx