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Evaluation of a digitally-enabled care pathway for acute kidney injury management in hospital emergency admissions.

Connell, A; Montgomery, H; Martin, P; Nightingale, C; Sadeghi-Alavijeh, O; King, D; Karthikesalingam, A; Hughes, C; Back, T; Ayoub, K; et al. Connell, A; Montgomery, H; Martin, P; Nightingale, C; Sadeghi-Alavijeh, O; King, D; Karthikesalingam, A; Hughes, C; Back, T; Ayoub, K; Suleyman, M; Jones, G; Cross, J; Stanley, S; Emerson, M; Merrick, C; Rees, G; Laing, C; Raine, R (2019) Evaluation of a digitally-enabled care pathway for acute kidney injury management in hospital emergency admissions. NPJ Digit Med, 2. p. 67. ISSN 2398-6352 https://doi.org/10.1038/s41746-019-0100-6
SGUL Authors: Nightingale, Claire

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Abstract

We developed a digitally enabled care pathway for acute kidney injury (AKI) management incorporating a mobile detection application, specialist clinical response team and care protocol. Clinical outcome data were collected from adults with AKI on emergency admission before (May 2016 to January 2017) and after (May to September 2017) deployment at the intervention site and another not receiving the intervention. Changes in primary outcome (serum creatinine recovery to ≤120% baseline at hospital discharge) and secondary outcomes (30-day survival, renal replacement therapy, renal or intensive care unit (ICU) admission, worsening AKI stage and length of stay) were measured using interrupted time-series regression. Processes of care data (time to AKI recognition, time to treatment) were extracted from casenotes, and compared over two 9-month periods before and after implementation (January to September 2016 and 2017, respectively) using pre-post analysis. There was no step change in renal recovery or any of the secondary outcomes. Trends for creatinine recovery rates (estimated odds ratio (OR) = 1.04, 95% confidence interval (95% CI): 1.00-1.08, p = 0.038) and renal or ICU admission (OR = 0.95, 95% CI: 0.90-1.00, p = 0.044) improved significantly at the intervention site. However, difference-in-difference analyses between sites for creatinine recovery (estimated OR = 0.95, 95% CI: 0.90-1.00, p = 0.053) and renal or ICU admission (OR = 1.06, 95% CI: 0.98-1.16, p = 0.140) were not significant. Among process measures, time to AKI recognition and treatment of nephrotoxicity improved significantly (p < 0.001 and 0.047 respectively).

Item Type: Article
Additional Information: Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing,adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visithttp://creativecommons.org/licenses/by/4.0/. © The Author(s) 2019
Keywords: Acute kidney injury, Outcomes research
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: NPJ Digit Med
ISSN: 2398-6352
Language: eng
Dates:
DateEvent
31 July 2019Published
27 February 2019Accepted
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 31396561
Web of Science ID: WOS:000478839900001
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111236
Publisher's version: https://doi.org/10.1038/s41746-019-0100-6

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