Descriptive study of differences in acute kidney injury progression patterns in General and Cardiac Intensive Care Units

Impact of a computerized decision support tool deployed in two intensive care units on acute kidney injury progression and guideline compliance: a prospective observational study

BACKGROUND

Acute kidney injury (AKI) affects a large proportion of the critically ill and is associated with worse patient outcomes. Early identification of AKI can lead to earlier initiation of supportive therapy and better management. In this study, we evaluate the impact of computerized AKI decision support tool integrated with the critical care clinical information system (CCIS) on patient outcomes. Specifically, we hypothesize that integration of AKI guidelines into CCIS will decrease the proportion of patients with Stage 1 AKI deteriorating into higher stages of AKI.

METHODS

The study was conducted in two intensive care units (ICUs) at University Hospitals Bristol, UK, in a before (control) and after (intervention) format. The intervention consisted of the AKIN guidelines and AKI care bundle which included guidance for medication usage, AKI advisory and dashboard with AKI score. Clinical data and patient outcomes were collected from all patients admitted to the units. AKI stage was calculated using the Acute Kidney Injury Network (AKIN) guidelines. Maximum AKI stage per admission, change in AKI stage and other metrics were calculated for the cohort. Adherence to eGFR-based enoxaparin dosing guidelines was evaluated as a proxy for clinician awareness of AKI.

RESULTS

Each phase of the study lasted a year, and a total of 5044 admissions were included for analysis with equal numbers of patients for the control and intervention stages. The proportion of patients worsening from Stage 1 AKI decreased from 42% (control) to 33.5% (intervention), p = 0.002. The proportion of incorrect enoxaparin doses decreased from 1.72% (control) to 0.6% (intervention), p < 0.001. The prevalence of any AKI decreased from 43.1% (control) to 37.5% (intervention), p < 0.05.

CONCLUSIONS

This observational study demonstrated a significant reduction in AKI progression from Stage 1 and a reduction in overall development of AKI. In addition, a reduction in incorrect enoxaparin dosing was also observed, indicating increased clinical awareness. This study demonstrates that AKI guidelines coupled with a newly designed AKI care bundle integrated into CCIS can impact patient outcomes positively.

Curation of an intensive care research dataset from routinely collected patient data in an NHS trust

In this data note we provide the details of a research database of 4831 adult intensive care patients who were treated in the Bristol Royal Infirmary, UK between 2015 and 2019. The purposes of this publication are to describe the dataset for external researchers who may be interested in making use of it, and to detail the methods used to curate the dataset in order to help other intensive care units make secondary use of their routinely collected data. The curation involves linkage between two critical care datasets within our hospital and the accompanying code is available online. For reasons of data privacy the data cannot be shared without researchers obtaining appropriate ethical consents. In the future we hope to obtain a data sharing agreement in order to publicly share the de-identified data, and to link our data with other intensive care units who use a Philips clinical information system.