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

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.

Keywords:

• Acute kidney injury
• electronic alerting
• care bundle
• renal failure
• quality improvement

Acknowledgements

The authors wish to gratefully acknowledge the assistance of the Information and Clinical Innovation Teams at West Suffolk Hospital, UK.

Ethical approval

This study was considered exempt from the need for ethical approval as it was deemed to be an audit of routinely collected data as part of a locally registered quality improvement project.

Authors’ contributions

MC-X: study design, data analysis and interpretation, manuscript drafting & revision. CK: study design, data extraction & interpretation, manuscript drafting & revision. EC: data extraction, manuscript revision. SR: data extraction, manuscript revision. VY (principal investigator): development of the ‘AKI order set’, study conception & design, data interpretation, manuscript revision.

Disclosure statement

The authors declare that they have no competing interests. The results presented in this paper have not been published previously in whole or part, except in abstract format.

Data availability statement

The data underlying this article cannot be shared publicly due to patient confidentiality requirements as unique patient identifiers were used to ascertain outcomes.

Additional information

Funding

The authors did not receive any funding for this research.