Association between e-alert implementation for detection of acute kidney injury and outcomes: a systematic review

Lachance, Philippe; Villeneuve, Pierre-Marc; Rewa, Oleksa G.; Wilson, Francis P.; Selby, Nicholas M.; Featherstone, Robin M.; Bagshaw, Sean M.

Abstract

Background. Electronic alerts (e-alerts) for acute kidney injury (AKI) in hospitalized patients are increasingly being implemented; however, their impact on outcomes remains uncertain.

Methods. We performed a systematic review. Electronic databases and grey literature were searched for original studies published between 1990 and 2016. Randomized, quasi-randomized, observational and before-and-after studies that included hospitalized patients, implemented e-alerts for AKI and described their impact on one of care processes, patient-centred outcomes or resource utilization measures were included.

Results. Our search yielded six studies (n = 10 165 patients). E-alerts were generally automated, triggered through electronic health records and not linked to clinical decision support. In pooled analysis, e-alerts did not improve mortality [odds ratio (OR) 1.05; 95% confidence intervals (CI), 0.84–1.31; n = 3 studies; n = 3425 patients; I2 = 0%] or reduce renal replacement therapy (RRT) use (OR 1.20; 95% CI, 0.91–1.57; n = 2 studies; n = 3236 patients; I2 = 0%). Isolated studies reported improvements in selected care processes. Pooled analysis found no significant differences in prescribed fluid therapy.

Conclusions. In the available studies, e-alerts for AKI do not improve survival or reduce RRT utilization. The impact of e-alerts on processes of care was variable. Additional research is needed to understand those aspects of e-alerts that are most likely to improve care processes and outcomes.

Citation

Lachance, P., Villeneuve, P.-M., Rewa, O. G., Wilson, F. P., Selby, N. M., Featherstone, R. M., & Bagshaw, S. M. (2017). Association between e-alert implementation for detection of acute kidney injury and outcomes: a systematic review. Nephrology Dialysis Transplantation, 32(2), https://doi.org/10.1093/ndt/gfw424

• Journal Article Type: Article
• Acceptance Date: Oct 28, 2016
• Publication Date: Jan 14, 2017
• Deposit Date: May 9, 2017
• Journal: Nephrology Dialysis Transplantation
• Print ISSN: 0931-0509
• Electronic ISSN: 1460-2385
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 32
• Issue: 2
• DOI: https://doi.org/10.1093/ndt/gfw424
• Keywords: acute kidney injury, clinical decision support, electronic alert, meta-analysis, systematic review
• Public URL: https://nottingham-repository.worktribe.com/output/840379
• Publisher URL: https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfw424
• Contract Date: May 9, 2017