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Lachance, Philippe and Villeneuve, Pierre-Marc and Rewa, Oleksa G. and Wilson, Francis P. and Selby, Nicholas M. and Featherstone, Robin M. and Bagshaw, Sean M. (2017) Association between e-alert implementation for detection of acute kidney injury and outcomes: a systematic review. Nephrology Dialysis Transplantation, 32 (2). pp. 265-272. ISSN 1460-2385

Abstract

Background. Electronic alerts (e-alerts) for acute kidney injury (AKI) in hospitalized patients are increasingly being implemented; however, their impact on outcomes remains uncertain.

Methods. We performed a systematic review. Electronic databases and grey literature were searched for original studies published between 1990 and 2016. Randomized, quasi-randomized, observational and before-and-after studies that included hospitalized patients, implemented e-alerts for AKI and described their impact on one of care processes, patient-centred outcomes or resource utilization measures were included.

Results. Our search yielded six studies (n = 10 165 patients). E-alerts were generally automated, triggered through electronic health records and not linked to clinical decision support. In pooled analysis, e-alerts did not improve mortality [odds ratio (OR) 1.05; 95% confidence intervals (CI), 0.84–1.31; n = 3 studies; n = 3425 patients; I2 = 0%] or reduce renal replacement therapy (RRT) use (OR 1.20; 95% CI, 0.91–1.57; n = 2 studies; n = 3236 patients; I2 = 0%). Isolated studies reported improvements in selected care processes. Pooled analysis found no significant differences in prescribed fluid therapy.

Conclusions. In the available studies, e-alerts for AKI do not improve survival or reduce RRT utilization. The impact of e-alerts on processes of care was variable. Additional research is needed to understand those aspects of e-alerts that are most likely to improve care processes and outcomes.

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