AKI Management Using Electronic Alerts

Acute kidney injury (AKI) is a common clinical event with severe consequences. In the United
States alone, greater than one million hospitalized patients per year are diagnosed with AKI.
It has been independently associated with prolonged hospital stays, 25-80% risk of
in-hospital death, and future progression to chronic kidney disease. While there has been an
increase in awareness about the prevalence and significance of AKI, studies have uncovered
systematic failure in the management of AKI, largely relating to the failure of clinicians to
recognize and manage the condition appropriately. This is where we can use electronic health
records (EHRs) and electronic alerts (e-alerts) to our advantage. In this study, the
investigators plan to use e-alerts integrated into a clinical decision support (CDS) system
to improve the care of and outcomes of patients with AKI. The aims are to study the
prevalence of AKI and its progression among hospitalized patients using an 'AKI sniffer' (an
EHR based automated system) and to prospectively study if introducing a complex intervention
(an e-alert combined with a clinical decision support system) will reduce progression of AKI
in children. The investigators have developed an AKI care bundle which provides simple
guidelines for management of AKI along with specific discharge instructions to improve follow
up care. The primary outcome is AKI progression. Secondary outcomes include morbidity,
mortality, length of hospital stay, need for renal replacement therapy, and recovery of renal
function by time of hospital discharge. The investigators will also look at documentation of
AKI and if these participants get appropriate follow up.