دورية أكاديمية
The Impact of Outpatient Laboratory Alerting Mechanisms in Patients with AKI.
| العنوان: | The Impact of Outpatient Laboratory Alerting Mechanisms in Patients with AKI. |
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| المؤلفون: | Tolan NV; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts., Ahmed S; Department of Medicine, Baylor College of Medicine, Houston, Texas., Terebo T; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts., Virk ZM; Harvard Medical School, Boston, Massachusetts., Petrides AK; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts., Ransohoff JR; Department of Epidemiology, Bloomberg School of Public Health, Baltimore, Maryland., Demetriou CA; Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus.; The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus., Kelly YP; Department of Critical Care Medicine, St. James Hospital, Dublin, Ireland., Melanson SEF; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts., Mendu ML; Harvard Medical School, Boston, Massachusetts.; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. |
| المصدر: | Kidney360 [Kidney360] 2021 Jul 14; Vol. 2 (10), pp. 1560-1568. Date of Electronic Publication: 2021 Jul 14 (Print Publication: 2021). |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology Country of Publication: United States NLM ID: 101766381 Publication Model: eCollection Cited Medium: Internet ISSN: 2641-7650 (Electronic) Linking ISSN: 26417650 NLM ISO Abbreviation: Kidney360 Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2023- : [Hagerstown, MD] : Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology Original Publication: [Washington, DC] : American Society of Nephrology, [2020]- |
| مواضيع طبية MeSH: | Acute Kidney Injury*/diagnosis , Outpatients*, Creatinine ; Hospitalization ; Humans |
| مستخلص: | Background: AKI is an abrupt decrease in kidney function associated with significant morbidity and mortality. Electronic notifications of AKI have been utilized in patients who are hospitalized, but their efficacy in the outpatient setting is unclear. Methods: We evaluated the effect of two outpatient interventions: an automated comment on increasing creatinine results (intervention I; 6 months; n =159) along with an email to the provider (intervention II; 3 months; n =105), compared with a control (baseline; 6 months; n =176). A comment was generated if a patient's creatinine increased by >0.5 mg/dl (previous creatinine ≤2.0 mg/dl) or by 50% (previous creatinine >2.0 mg/dl) within 180 days. Process measures included documentation of AKI and clinical actions. Clinical outcomes were defined as recovery from AKI within 7 days, prolonged AKI from 8 to 89 days, and progression to CKD with in 120 days. Results: Providers were more likely to document AKI in interventions I ( P =0.004; OR, 2.80; 95% CI, 1.38 to 5.67) and II ( P =0.01; OR, 2.66; 95% CI, 1.21 to 5.81). Providers were also more likely to discontinue nephrotoxins in intervention II ( P <0.001; OR, 4.88; 95% CI, 2.27 to 10.50). The median time to follow-up creatinine trended shorter among patients with AKI documented (21 versus 42 days; P =0.11). There were no significant differences in clinical outcomes. Conclusions: An automated comment was associated with improved documented recognition of AKI and the additive intervention of an email alert was associated with increased discontinuation of nephrotoxins, but neither improved clinical outcomes. Translation of these findings into improved outcomes may require corresponding standardization of clinical practice protocols for managing AKI. Competing Interests: M.L. Mendu reports having consultancy agreements with Bayer AG. N.V. Tol an reports receiving research funding from Abbott Diabetes Care and Biomerieux; and reports being a scientific advisor or member of the American Association for Clinical Chemistry, College of American Pathologists, and the Journal of Applied Laboratory Medicine. S. Ahmed reports having an ownership interest in The Kidney Health and Preventive Medicine Institute. All remaining authors have nothing to disclose. (Copyright © 2021 by the American Society of Nephrology.) |
| التعليقات: | Comment in: Kidney360. 2021 Oct 28;2(10):1549-1550. (PMID: 35372976) |
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| فهرسة مساهمة: | Keywords: acute kidney injury; acute kidney injury and ICU nephrology; creatinine; documentation; laboratory alerts; nephrotoxins; outcomes; outpatients |
| المشرفين على المادة: | AYI8EX34EU (Creatinine) |
| تواريخ الأحداث: | Date Created: 20220404 Date Completed: 20220407 Latest Revision: 20240405 |
| رمز التحديث: | 20240405 |
| مُعرف محوري في PubMed: | PMC8785781 |
| DOI: | 10.34067/KID.0003312021 |
| PMID: | 35372977 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 2641-7650 |
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| DOI: | 10.34067/KID.0003312021 |