Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
Best Pract Res Clin Anaesthesiol. 2017 Sep;31(3):353-359. doi: 10.1016/j.bpa.2017.08.003. Epub 2017 Aug 24.
With the recent advancement in electronic health record systems and meaningful use of information technology incentive programs (i.e., the American Recovery and Reinvestment Act, the Health Information Technology for Economic and Clinical Health Act, and the Centers for Medicare & Medicaid Services), interest in clinical decision support systems has risen. These systems have been used to examine a variety of different syndromes with variable reported effects. In recent years, electronic alerts (e-alerts) have been implemented at various institutions to decrease the morbidity associated with acute kidney injury (AKI). AKI is common, accounting for 1 in 7 hospital admissions, and is associated with increased length of hospital stay and mortality. AKI is often underrecognized, causing delayed intervention. The use of e-alerts may result in earlier recognition and intervention, as well as decreased morbidity and mortality. This must be balanced with the possibility of increased resource utilization that e-alerts may cause. Before widespread implementation, the ethical and legal consequences of not following e-alert recommendations must be established, and the optimal algorithm for AKI e-alert detection must be determined.
随着电子健康记录系统和信息技术的有效利用激励计划（即美国复苏和再投资法案、医疗信息技术经济和临床健康法案以及医疗保险和医疗补助服务中心）的最近进展，临床决策支持系统的兴趣日益增加。这些系统已被用于检查各种不同的综合征，其报告的效果不同。近年来，电子警报（e-alerts）已在各个机构实施，以降低与急性肾损伤（AKI）相关的发病率。AKI 很常见，占医院入院人数的 1/7，与住院时间延长和死亡率增加有关。AKI 常常被低估，导致干预延迟。使用 e-alerts 可能会更早地识别和干预，并降低发病率和死亡率。这必须与 e-alerts 可能导致的资源利用增加的可能性相平衡。在广泛实施之前，必须确定不遵守 e-alert 建议的伦理和法律后果，并且必须确定 AKI e-alert 检测的最佳算法。
