AKI Management Using Electronic Alerts

Seattle Children's Healthcare System

Status: Completed

Conditions: Acute Kidney Injury

Treatments: Other: electronic alert and clinical decision support system

Study type: Interventional

Funder types: Other

Identifiers

NCT03538769

STUDY00000811

Details and patient eligibility

About

Acute kidney injury (AKI) is a common clinical event with severe consequences. In the United States alone, greater than one million hospitalized patients per year are diagnosed with AKI. It has been independently associated with prolonged hospital stays, 25-80% risk of in-hospital death, and future progression to chronic kidney disease. While there has been an increase in awareness about the prevalence and significance of AKI, studies have uncovered systematic failure in the management of AKI, largely relating to the failure of clinicians to recognize and manage the condition appropriately. This is where we can use electronic health records (EHRs) and electronic alerts (e-alerts) to our advantage. In this study, the investigators plan to use e-alerts integrated into a clinical decision support (CDS) system to improve the care of and outcomes of patients with AKI. The aims are to study the prevalence of AKI and its progression among hospitalized patients using an 'AKI sniffer' (an EHR based automated system) and to prospectively study if introducing a complex intervention (an e-alert combined with a clinical decision support system) will reduce progression of AKI in children. The investigators have developed an AKI care bundle which provides simple guidelines for management of AKI along with specific discharge instructions to improve follow up care. The primary outcome is AKI progression. Secondary outcomes include morbidity, mortality, length of hospital stay, need for renal replacement therapy, and recovery of renal function by time of hospital discharge. The investigators will also look at documentation of AKI and if these participants get appropriate follow up.

Enrollment: 240 patients

Sex: All

Ages: 6 months to 18 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

All patients between 6 months-18 years admitted to the surgical and medical floors of Seattle Children's Hospital

Exclusion criteria

1. History of chronic kidney disease stage 4 or worse (i.e., patients on chronic renal replacement therapy or glomerular filtration rate < 30 mL/min/1.73 m2)
2. History of renal transplantation within the last 3 months
3. History of nephrectomy within last 3 months
4. Patients admitted to observation units

Trial design

Primary purpose: Supportive Care

Allocation: Non-Randomized

Interventional model: Single Group Assignment

Masking: None (Open label)

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240 participants in 2 patient groups

Baseline group

No Intervention group

Description:

This will be the pre and post alert phase where e-alerts will not be sent to providers

Alert group

Other group

Description:

This will be the phase when e-alerts will be sent to the provider

Treatment:

Other: electronic alert and clinical decision support system