Early, Individualized Recommendations for Hospitalized Patients With Acute Kidney Injury: A Randomized Clinical Trial
A trial of automated, expert kidney-action-team recommendations delivered through the electronic health record for hospitalized AKI patients did not improve outcomes, despite increasing how often recommendations were implemented.
Background
AKI is a common hospital complication associated with adverse outcomes. Whether early, individualized diagnostic and therapeutic recommendations delivered electronically can improve outcomes was unknown.
Study design
This RCT at 7 hospitals across two US health systems randomized 4,003 hospitalized adults with AKI. A kidney action team (study physician plus pharmacist) generated personalized recommendations across five categories within 1 hour of AKI detection; the note was delivered only to clinicians of patients in the intervention group.
Key findings
The primary composite outcome (AKI progression, dialysis, or death within 14 days) occurred in 19.8% of the intervention group versus 18.4% of usual care (difference 1.4%; 95% CI -1.1% to 3.8%; P=0.28). Recommendation implementation within 24 hours was higher in the intervention group (33.8% vs 24.3%).
Clinical implications
Electronic delivery of expert AKI recommendations increased implementation but did not improve clinical outcomes, suggesting that alerts alone are insufficient and that more intensive implementation or better-targeted patient selection is needed.
Category
Research
Source
JAMA
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