JMIR Publications

ABSTRACT

Background:

The development of Acute Kidney Injury in hospitalized patients is associated with adverse outcomes and increased healthcare costs. Simple ‘automated e-alerts’ to its presence do not appear to improve outcomes, perhaps because of a lack of explicitly defined integration with a clinical response.

Objective:

We sought to test this hypothesis by evaluating the impact of a digitally-enabled intervention on clinical outcomes and healthcare costs associated with AKI in hospitalized patients.

Methods:

We developed a care pathway comprising automated AKI detection, mobile clinician notification, in-application triage and a protocolised specialist clinical response. We evaluated its impact by comparing data from pre- and post-implementation phases (May 2016-January 2017 and May-September 2017 respectively) at the intervention site and another site not receiving the intervention. Clinical outcomes were analysed using segmented regression analysis. The primary outcome was recovery of renal function to <120% of baseline by hospital discharge. Secondary clinical outcomes were mortality within 30 days of alert; progression of AKI stage; transfer to renal/intensive care units; hospital readmission within 30 days of discharge; dependence on renal replacement therapy 30 days after discharge; and hospital-wide cardiac arrest rate. Time taken for specialist review of AKI alerts was measured. Impact on healthcare costs as defined by Patient-Level Information and Costing System data was evaluated using difference-in-differences analysis.

Results:

The median time to AKI alert review by a specialist was 14.0 minutes (interquartile range 1.0-60.0 minutes). There was no impact on the primary outcome (estimated odds ratio (OR)=1.00, 95% Confidence Interval (95%CI)= 0.58-1.71 P=.99). Whilst the hospital-wide cardiac arrest rate fell significantly at the intervention site (OR=0.55 95%CI=0.38-0.76 P<.001), difference-in-differences analysis with the comparator site was not significant (OR=1.13 95%CI=0.63-1.99 P=.69). There was no impact on other secondary clinical outcomes. Mean healthcare costs per patient were reduced by £2123 (95%CI= -£4024 - -£222 P=.03), not including costs of providing the technology.

Conclusions:

The digitally-enabled clinical intervention to detect and treat AKI in hospitalized patients reduced healthcare costs and possibly reduced cardiac arrest rates. Its impact on other clinical outcomes and identification of the ‘active’ components of the pathway requires clarification through evaluation across multiple sites.