Authors: Jennifer Baker, MD; Christopher Droege PharmD; Jay Johannigman, MD; John Holcomb, MD; Michael Goodman, MD; Timothy Pritts, MD, PhD
Acute kidney injury (AKI) is a secondary insult in critically illness associated with an increase in morbidity and mortality. Analyzing and determining the extent of AKI is challenging. Use of a visual clinical decision support tool with validated staging and recognition for AKI may be helpful in identifying patients transitioning into different stages of injury severity.
A commercially available clinical surveillance and decision support dashboard system was implemented in 12 of the 34 beds in a surgical intensive care unit (SICU) at an academic medical and regional level I trauma center. An automated AKI bundle based on the Kidney Disease: Improve Global Outcomes (KDIGO) criteria stages was implemented to aid in identification of patients in various stages. A pre-and-post analysis was performed on SICU beds with (WDB) and without the dashboard (WODB) to assess the impact of the bundle to identify patients with AKI and minimize ongoing renal dysfunction. Data five months prior to and 14 months after implementation were compared. Patients with known chronic or end-stage renal disease were excluded.
A total of 2813 patients were included: 988 patients in WDB and 1825 patients in WODB. Age and gender were similar in patients WDB and WODB pre-and post-implementation. Overall AKI incidence was reduced in WDB after implementation (pre, 28.8% v post, 22.4%; p=0.04). Individual KDIGO stages of AKI were reduced in WDB post-implementation, but none were statistically significant. There were no differences in overall AKI incidence (pre-26.6% v post-25.7%; p=0.682) or individual KDIGO stages in WODB. Length of stay in the SICU or hospital was similar in all patients and on subgroup analysis between individual KDIGO stages. No difference in mortality was demonstrated between WDB and WODB cohorts.
Implementation of a visual clinical decision support tool was associated with a statistically significant decrease in overall AKI incidence in patients WDB. Integration of an AKI bundle within this tool in SICU patients may aid clinicians to identify AKI in real time and rapidly adjust medications or implement therapies to improve quality of care.