Kidney care recommendations, not alerts, increased best practices for hospitalized adults
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Key takeaways:
- Timely recommendations by a kidney care team entered into the health record significantly increased kidney care testing and treatment.
- The recommendations did not affect kidney outcomes.
SAN DIEGO — More in-patients with AKI quickly received care based on best practices when a kidney action team sent recommendations to health care providers via electronic health records, according to study data.
“Clinical decision support tools such as electronic alerts have improved adherence to best practice in conditions such as sepsis, heart failure and [venous thromboembolisms] VTEs and improved outcomes in sepsis and VTEs and have therefore emerged as attractive tools to improve outcomes for patients with AKI,” Abinet M. Aklilu, MD, MPH, an instructor in the nephrology section in the department of medicine at Yale School of Medicine, said during a press briefing at ASN Kidney Week.
However, trials of electronic alerts in AKI care have not shown a benefit in outcomes or implementation of best practices, possibly due to “alert fatigue,” she said.
Aklilu and colleagues designed an intervention around recommendations from a kidney action team made up of a physician and a pharmacist. In a randomized controlled trial conducted in two health systems from Oc. 29, 2021, to Feb. 8, 2024, hospitalized patients who met at least one Kidney Disease: Improving Global Outcomes criterion for AKI were reviewed by a kidney action team that made individual treatment recommendations and assigned patients to either the intervention group (n = 1,999), which had recommendations entered into the EHR and health care providers were notified, or to the usual care group (n = 2,004) with no recommendations or notification of AKI entered into the EHR. The team only made recommendations that were not already untaken by care providers. Primary outcome of the study was death, dialysis or AKI progression at 14 days.
Of the 14,539 recommendations generated, the median number per patient was three and median time from AKI detection to recommendations was 56 minutes. Of the recommendations generated, 80% were related to volume, 55% to medication, 16% to potassium level, 10% to acid base and 2% to renal consultation, according to Aklilu.
“We were surprised, especially with how many patients, the proportion of patients, that required medication adjustments at the time of AKI detection. It was much higher than expected,” Aklilu told Healio.
There was no significant difference in the primary outcome between groups.
Researchers assessed the implementation of recommendations for both groups, that is, regardless of whether the recommendations had been entered into the EHR. Significantly more recommendations were implemented within 24 hours in the study group (33.8%) than in the usual care group (24.3%), according to researchers.
“We were also surprised with the levels of adherence for these recommendations, that it improved adherence despite not being ‘in their face’ like an alert and being embedded into the notes,” Aklilu told Healio. “People were following the recommendations. In many environments, especially in some ICUs, people are busy and there are so many alerts, so we just ignore those.”
Results were published simultaneously in JAMA.
Reference:
Aklilu AM, et al. JAMA. 2024:doi:10.1001/jama.2024.22718.
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Aklilu AM, et al. FR-OR101. Presented at: ASN Kidney Week; Oct. 24-27, 2024; San Diego.
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