Identification of AKI using electronic reporting: does it ... - CRRT Online

Published experience withelectronic alerts for AKI

Royal Derby Hospital• 1100 bedded teachinghospital• Tertiary referral renalunit• Central lab for all inptand outpt bloodsamples

Combination of IT and human algorithmsBased on serum creatinine criteria onlyDisregards time window when selectingbaseline

Serum creatinine measuredIn-patient location?(renal ward and dialysis unit excluded)No – process endsCreatinine >1.5x ‘ideal’ creatinine(measured from reverse eGFR)No – process endsAuthoriser vets results; selects truebaseline and inputs to AKI calculatorNo AKI, result notflaggedReport issued: AKI stage 1Combination of IT and human algorithmsBased on serum creatinine criteria onlyDisregards time window when selectingbaselineReport issued: AKI stage 2Report issued: AKI stage 3

Baseline creatinineused and date alsoincluded

Results from initial 9 months• Total blood samples: 17,489• Samples with AKI: 6,047• AKI episodes: 3,202• No. of patients: 2,652• Median age 80yrs (IQR 16)• 92% non-elective admissions• False –ve rate: 0.2%• False +ve rate: 1.7%Valid123TotalHighest AKI stageCumulativeFrequency Percent Valid Percent Percent1970 61.5 61.5 61.5638 19.9 19.9 81.4594 18.6 18.6 100.03202 100.0 100.0Selby NM et al, in press CJASN 20

Predictive value of AKI stagingdepends on baseline creatinineNormal baseline renal functionBaseline CKDp=0.046p=0.225Selby NM et al, in press CJASN 2

Renal replacement therapy• 90 (3.4% of total group) patients required RRTOf those that required RRT:• 7 (7.8%) remained dialysis dependent• 63 (70%) became dialysis independent• 20 (22.2%) died still requiring RRT• Overall mortality in those that received RRT: 42.6%Selby NM et al, in press CJASN 20

In-hospital AKI associated withworse outcomesp

Renal recovery at hospital• Complete recovery: 73.1%discharge• Incomplete/no recovery: 26.9%p

Electronic reporting in AKI can beeffectiveTime to intervention: 97.5hrsvs. 75.9hrs(control vs. e-alerts, p

Audit afterintroduction of AKIreportingMedication reviewUrinalysisRenal imaging

AKI distribution acrossspecialties7.5% of patients under nephrologySelby NM et al, in press CJASN 20

Outcomes since multi-facetedUnadjusted mortality perquarterinterventions% AKI pts in stage 3 perquarterp=0.03

Summary• Hospital-wide electronic reporting of AKI isfeasible in clinical practice• Early identification of AKI is an importanttool in improving standards in AKI• Effectiveness maximised by combiningwith other strategies