Acute Kidney Injury
Conditions
Brief summary
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.
Interventions
OTHERelectronic alert and clinical decision support system
Providers taking care of patients will receive an electronic alert and will be guided to use a clinical decision support system
Sponsors
Seattle Children's Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
6 Months to 18 Years
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| AKI documentation | 28 days | Documentation of AKI in progress notes and discharge summary |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| AKI progression | 7 days | Progression of AKI from Stage 1 to Stage 2/3 |
Countries
United States
Outcome results
None listed