Electronic alerts for acute kidney injury.
PURPOSE OF REVIEW: Acute kidney injury (AKI) is extremely common in hospitalized patients and its presence infers a poorer chance of survival, longer hospital stays and an increased risk of subsequent chronic kidney disease. Recent reports have suggested that standards of care for patients with AKI are often suboptimal and that this contributes to poor outcomes. In an attempt to address delays in diagnosing AKI, there has been increasing interest in e-alert systems for AKI. This review aims to discuss recent developments in e-alert methodologies, as well as examining the evidence to support their effectiveness. RECENT FINDINGS: Several e-alert systems for AKI have been reported, including more recent descriptions of hospital-wide systems that apply current diagnostic criteria and run sustainably in routine clinical practice. Evidence is accumulating to show their impact in altering physician behaviour and triggering earlier intervention. Emerging data suggest that in combination with other service improvement strategies, this may translate into improved patient outcomes. SUMMARY: The current ad-hoc development of e-alert systems needs to be addressed by arriving at consensus around the way in which these systems should apply diagnostic criteria, particularly with respect to selection of baseline creatinine value. Enhancements in IT provision may provide the only durable solution to this, while at the same time facilitating wider uptake. Wider use will allow for further study of the value of e-alerts, including their use in other settings such as primary care.