The Impact of Outpatient Laboratory Alerting Mechanisms in Patients with Acute Kidney Injury

Background: Acute kidney injury (AKI) is an abrupt decrease in kidney function associated with significant morbidity and mortality. Electronic notifications of AKI have been utilized in hospitalized patients, but their efficacy in the outpatient setting is unclear. Methods: We evaluated the impact 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 to a control (baseline; 6 months; n=176). A comment was generated if a patient9s 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, progression to CKD within 120 days. Results: Providers were more likely to document AKI in interventions I (p=0.004; OR=2.80) and II (p=0.01; OR=2.66). Providers were also more likely to discontinue nephrotoxins in intervention II (p