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Electronic alerts result in earlier creatinine monitoring
Electronic alert implementation was associated with higher rates of earlier creatinine monitoring in primary care patients with acute kidney disease, according to findings recently published in Clinical Kidney Journal.
“We wanted to establish whether introduction of e-alerts for acute kidney injury led to change in clinician behavior within primary care compared to before the alerts were introduced,” Samira Bell, MBChB, MD, consultant nephrologist and honorary senior clinical lecturer at the University of Dundee in the U.K., told Healio.com/Family Medicine, adding there was “very little work” examining these alerts’ impact in such settings prior to their investigation.
Researchers found prior to electronic alert implementation, 8,812 acute kidney injury episodes were identified, and among those, 30.1% were requested by primary care staff. The median duration to repeat creatinine testing was 55 days (interquartile range [IQR], 20-142) for stage 1 of acute kidney injury, 38 days (IQR, 15-128) for stage 2 and 53 days (IQR, 20-137) for stage 3.
However, during the 12 months after electronic alerts were implemented, 9,781 acute kidney injury e-alerts were generated, of which 14.9% were from primary care staff. The median duration to repeat blood testing for these primary care alerts was 5 days for acute kidney injury stage 1 (IQR, 2-10), 2 days for stage 2 (IQR, 1-5) and 1 day (IQR, 0-2) for stage 3.
Bell and colleagues also found that hospitalization rates within 7 days of acute kidney injury increased from 12.9% pre-alert implementation to 25.5% after (P < .001).
Researchers noted they could not rule out the possibility the higher rates of creatinine monitoring could be attributed to greater awareness of acute injury, rather than the electronic alert. That limitation aside, Bell said the results of their observational study — as opposed to conducting a clinical trial — suggest electronic alerts would be helpful in detecting acute kidney injury in primary care.
“We plan to see if this change in practice has translated into improved patient outcomes since the introduction of the alerts,” she added. – by Janel Miller
Disclosures: The authors report no relevant financial disclosures.
Perspective
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This study is unique in that the target of the electronic alerts in this study were primary care patients. Previous studies have examined the efficacy of electronic alerts in hospitalized patients with acute kidney injury. Electronic alerts in the primary care setting offers the potential for detecting acute kidney injury early, potentially reducing the severity of injury and reducing morbidity and mortality.
In general, electronic alerts must be coupled with a process that requires action by the provider. For example, if an alert is sent it must trigger a response by the primary care physicians. The electronic alerts should be coupled with relevant information regarding the management of the patient’s medical condition to further enhance the alerts’ effectiveness. Past studies have had mixed results on the type of education that makes the biggest impact — pamphlets, webinars, medical conferences, link to internet-based guidelines, etc.; but it’s combining the alert with an educational method that will likely cause the greatest, most positive impact on a patient’s well-being.
Aiyegbusi and colleagues found that the implementation of electronic alert system was associated with more frequent creatinine monitoring and higher rates of hospitalization. Limitations of the study include the fact that the study examines two different periods of time, approximately 3 years apart. We do not know if it was the electronic alert that prompted more frequent creatinine monitoring as well as hospitalization, or if clinical practice had changed over the 3-year period. Lastly, there was no data on mortality. These studies, nevertheless provide new information that indicates that electronic alerts in acute kidney injury may be useful in the primary care setting. Larger randomized studies will be needed in the future to determine the efficacy of electronic alerts for acute kidney injury the primary care setting.