在基层医疗中引入电子急性肾损伤警报的影响。
Impact of introducing electronic acute kidney injury alerts in primary care.
作者信息
Aiyegbusi Oshorenua, Witham Miles D, Lim Michelle, Gauld Graham, Bell Samira
机构信息
Renal Unit, Ninewells Hospital, Dundee, UK.
Ageing and Health, Division of Molecular & Clinical Medicine School of Medicine, Ninewells Hospital, Dundee, UK.
出版信息
Clin Kidney J. 2018 Oct 3;12(2):253-257. doi: 10.1093/ckj/sfy083. eCollection 2019 Apr.
BACKGROUND
Acute kidney injury (AKI) is associated with decreased survival, future risk of chronic kidney disease and longer hospital stays. Electronic alerts (e-alerts) for AKI have been introduced in the UK in order to facilitate earlier detection and improve management. The aim of this study was to establish if e-alerts in primary care were acted on by examining timing of repeat creatinine testing.
METHODS
The National Health Service England Acute Kidney Injury electronic alert algorithm was introduced in April 2015 across both primary and secondary care in NHS Tayside accompanied by a programme of education. Data from a 12-month period (2012) predating introduction of the e-alerts were compared with a 12-month period following implementation of e-alerts for AKI. Biochemistry testing following the AKI episode, timing of repeat tests and numbers of patients hospitalized within 7 days of episode were compared between the two time periods.
RESULTS
During the 12 months after e-alert introduction, 9781 AKI e-alerts were generated. Of these, 1460 (14.9%) alerts were generated in primary care. Median duration to repeat blood testing for these primary care alerts was 5 days for AKI Stage 1 [interquartile range (IQR) 2-10], 2 days for Stage 2 (IQR 1-5) and 1 day (IQR 0-2) for Stage 3. During 2012 (prior to e-alert implementation) 8812 AKI episodes were identified. Of these, 2650 tests (30.1%) were requested by primary care staff. Median duration to repeat creatinine testing was longer: 55 days (IQR 20-142) for Stage 1, 38 days (IQR 15-128) for Stage 2 was and 53 days (IQR 20-137) for Stage 3. More patients had biochemistry tests repeated within 7 days of AKI onset, pre-alert implementation; 252 (9.5%) versus 857 (58.7%) (P < 0.001). Rates of hospitalization within 7 days of AKI increased from 342 (12.9%) pre-implementation to 372 (25.5%) post-implementation (P < 0.001).
CONCLUSIONS
Within primary care, e-alert implementation was associated with higher rates of creatinine monitoring, but also higher rates of hospitalization.
背景
急性肾损伤（AKI）与生存率降低、未来患慢性肾病的风险以及更长的住院时间相关。英国已引入AKI电子警报（e - 警报），以促进早期检测并改善管理。本研究的目的是通过检查重复肌酐检测的时间来确定初级保健中的e - 警报是否得到了执行。
方法
2015年4月，英国国家医疗服务体系（NHS）泰赛德地区的初级和二级保健机构引入了英格兰国民保健服务急性肾损伤电子警报算法，并伴有一项教育计划。将e - 警报引入前12个月（2012年）的数据与AKI电子警报实施后的12个月数据进行比较。比较两个时间段内AKI发作后的生化检测、重复检测的时间以及发作后7天内住院的患者数量。
结果
在引入e - 警报后的12个月内，共生成了9781条AKI e - 警报。其中，1460条（14.9%）警报是在初级保健中生成的。这些初级保健警报的重复血液检测中位持续时间，AKI 1期为5天[四分位间距（IQR）2 - 10]，2期为2天（IQR 1 - 5），3期为1天（IQR 0 - 2）。2012年（e - 警报实施前）共识别出8812例AKI发作。其中，2650次检测（30.1%）是由初级保健人员要求的。重复肌酐检测的中位持续时间更长：1期为55天（IQR 20 - 142），2期为38天（IQR 15 - 128），3期为53天（IQR 20 - 137）。在AKI发作后7天内进行重复生化检测的患者更多，在e - 警报实施前为252例（9.5%），实施后为857例（58.7%）（P < 0.001）。AKI发作后7天内的住院率从实施前的342例（12.9%）增加到实施后的372例（25.5%）（P < 0.001）。
结论
在初级保健中，e - 警报的实施与更高的肌酐监测率相关，但也与更高的住院率相关。
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