In a new study published October 25th in the Journal of the American Medical Association, Yale School of Medicine researchers set out to test whether rapidly delivered, personalized care recommendations from a dedicated “kidney action team” could improve outcomes for hospitalized patients with acute kidney injury (AKI).
“Because acute kidney injury during hospitalization has many causes, and diagnosis is difficult, we hypothesized that part of the reason it is associated with poor outcomes is that providers don’t understand how to go about the diagnostic testing when it first starts, and potentially what treatment recommendations could be implemented early,” said F. Perry Wilson, MD, associate professor of medicine (nephrology) in the Yale Department of Internal Medicine and senior author of the study.
Researchers created a kidney action team consisting of a clinician and a pharmacist trained in AKI management, which provided diagnostic and therapeutic recommendations starting the moment a patient developed AKI. “Personalized, expert driven recommendations delivered to the primary team within an hour of AKI detection is pretty impressive,” Wilson said. “This was facilitated by a framework that allowed our experts to simply click on potential recommendations and then those choices would be automatically integrated into a clinical note, and it saved a ton of time.”
Patients randomly assigned to the experimental group had the team’s recommendations added as a note to their electronic health record, while patients in the “usual care” group did not. Researchers say in the intervention group, 34% of the team’s recommendations were followed, compared to 24% in the usual care group – a highly significant difference. However, there was no difference between the two groups in clinical patient outcomes.
“This might be telling us that we need to focus on a subgroup of patients with acute kidney injury, a specific phenotype of acute kidney injury or perhaps patients admitted to certain units,” said Abinet Aklilu, MD, Instructor of Medicine (Nephrology) and first author of the study.
Researchers say clinical decision support (CDS) alert systems are unlikely to be fully embraced until they’re shown to improve the outcomes patients care about. “It’s time to take these CDS interventions to the next level and prove that they actually improve patient outcomes, which has been hard to show,” Wilson said.
Other YSM authors of the study include Dennis Moledina, Yu Yamamoto, Fan Li, Jeffrey Testani, Bashar Kadhim, Sophia Faulkner, Kyle O’Connor, Megan Baker, Jiawei Tan, Simon Correa Gaviria, Kyra Shelton, Melissa Martin, Claudia Coronel-Moreno, and Amrita Makhijani. Lead pharmacists from Yale New Haven Hospital include Kristina Shvets and Charles Jones. Research grant #AHRQ R01HS027626.
