Impact of electronic AKI alert/care bundle on AKI inpatient outcomes: a retrospective single-center cohort study.

IF 3 3区医学 Q1 UROLOGY & NEPHROLOGY Renal Failure Pub Date : 2024-12-01 Epub Date: 2024-02-12 DOI:10.1080/0886022X.2024.2313177

Michael Chen-Xu, Christopher Kassam, Emma Cameron, Szymon Ryba, Vivian Yiu

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Abstract

Background: Outcomes among acute kidney injury (AKI) patients are poor in United Kingdom (UK) hospitals, and electronic alerts and care bundles may improve them. We implemented such a system at West Suffolk Hospital (WSH) called the 'AKI order set'. We aimed to assess its impact on all-cause mortality, length of stay (LOS) and renal function among AKI patients, and its utilization.

Methods: Retrospective, single-center cohort study of patients ≥ 18 years old with AKI at WSH, a 430-bed general hospital serving a rural UK population of approximately 280,000. 7243 unique AKI events representing 5728 patients with full data were identified automatically from our electronic health record (EHR) between 02 September 2018 and 1 July 2021 (median age 78 years, 51% male). All-cause mortality, LOS and improvement in AKI stage, demographic and comorbidity data, medications and AKI order set use were automatically collected from the EHR.

Results: The AKI order set was used in 9.8% of AKI events and was associated with 28% lower odds of all-cause mortality (multivariable odds ratio [OR] 0.72, 95% confidence interval [CI] 0.57-0.91). Median LOS was longer when the AKI order set was utilized than when not (11.8 versus 8.8 days, p < .001), but was independently associated with improvement in the AKI stage (28.9% versus 8.7%, p < .001; univariable OR 4.25, 95% CI 3.53-5.10, multivariable OR 4.27, 95% CI 3.54-5.14).

Conclusions: AKI order set use led to improvements in all-cause mortality and renal function, but longer LOS, among AKI patients at WSH.

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电子 AKI 警报/护理捆绑对 AKI 住院患者预后的影响：一项回顾性单中心队列研究。

背景：在英国的医院里，急性肾损伤（AKI）患者的治疗效果很差，而电子警报和护理捆绑可以改善他们的治疗效果。我们在西萨福克医院（WSH）实施了名为 "AKI 订单集 "的系统。我们旨在评估该系统对 AKI 患者全因死亡率、住院时间（LOS）和肾功能的影响及其使用情况：回顾性单中心队列研究：WSH 是一家拥有 430 张床位的综合医院，服务于英国约 28 万农村人口，研究对象为年龄≥ 18 岁的 AKI 患者。在2018年9月2日至2021年7月1日期间，从我们的电子健康记录（EHR）中自动识别出了7243个独特的AKI事件，代表了5728名拥有完整数据的患者（中位年龄78岁，51%为男性）。从 EHR 中自动收集了全因死亡率、LOS 和 AKI 阶段改善情况、人口统计学和合并症数据、药物和 AKI 订单集使用情况：结果：9.8%的 AKI 事件使用了 AKI 医嘱集，全因死亡率降低了 28%（多变量几率比 [OR] 0.72，95% 置信区间 [CI] 0.57-0.91）。使用 AKI 医嘱集时的中位住院日比未使用时长（11.8 天对 8.8 天，P P 结论：使用 AKI 医嘱集后，WSH 的 AKI 患者的全因死亡率和肾功能均有所改善，但住院时间更长。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Renal Failure 医学-泌尿学与肾脏学

CiteScore

3.90

自引率

13.30%

发文量

374

审稿时长

1 months

期刊介绍： Renal Failure primarily concentrates on acute renal injury and its consequence, but also addresses advances in the fields of chronic renal failure, hypertension, and renal transplantation. Bringing together both clinical and experimental aspects of renal failure, this publication presents timely, practical information on pathology and pathophysiology of acute renal failure; nephrotoxicity of drugs and other substances; prevention, treatment, and therapy of renal failure; renal failure in association with transplantation, hypertension, and diabetes mellitus.