title: Impact of electronic-alerting of acute kidney injury: workgroup statements from the 15(th) ADQI Consensus Conference.
abstract: OBJECTIVE
  Among hospitalized patients, acute kidney injury is common and associated with significant morbidity and risk for mortality. The use of electronic health records (EHR) for prediction and detection of this important clinical syndrome has grown in the past decade. The steering committee of the 15(th) Acute Dialysis Quality Initiative (ADQI) conference dedicated a workgroup with the task of identifying elements that may impact the course of events following Acute Kidney Injury (AKI) e-alert.
  
  
  METHODS
  Following an extensive, non-systematic literature search, we used a modified Delphi process to reach consensus regarding several aspects of the utilization of AKI e-alerts.
  
  
  RESULTS
  Topics discussed in this workgroup included progress in evidence base practices, the characteristics of an optimal e-alert, the measures of efficacy and effectiveness, and finally what responses would be considered best practices following AKI e-alerts. Authors concluded that the current evidence for e-alert system efficacy, although growing, remains insufficient. Technology and human-related factors were found to be crucial elements of any future investigation or implementation of such tools. The group also concluded that implementation of such systems should not be done without a vigorous plan to evaluate the efficacy and effectiveness of e-alerts. Efficacy and effectiveness of e-alerts should be measured by context-specific process and patient outcomes. Finally, the group made several suggestions regarding the clinical decision support that should be considered following successful e-alert implementation.
  
  
  CONCLUSIONS
  This paper reflects the findings of a non-systematic review and expert opinion.
  
  
  CONCLUSIONS
  We recommend implementation of the findings of this workgroup report for use of AKI e-alerts.
authors.affiliation: Intensive Care Unit, Ghent University Hospital, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium ; Research Foundation-Flanders (FWO), Brussels, Belgium.
authors.forename: Eric A J
authors.initials: EA
authors.lastname: Hoste
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First St, SW, Rochester, MN USA ; Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First St, SW, Rochester, MN USA.
authors.forename: Kianoush
authors.initials: K
authors.lastname: Kashani
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, CSB 2-124, 8440-112 Street, Edmonton, AB Canada.
authors.forename: Noel
authors.initials: N
authors.lastname: Gibney
authors.affiliation: Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, 60 Temple Street Suite 6C, New Haven, CT 06510 USA.
authors.forename: F Perry
authors.initials: FP
authors.lastname: Wilson
authors.affiliation: Department of Nephrology and International Renal Research Institute, Ospedale San Bortolo, Vicenza, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
authors.affiliation: Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7022, Cincinnati, OH 45229 USA.
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldstein
authors.affiliation: Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440-112 ST NW, Edmonton, AB T6G2B7 Canada.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
keywords: Acute kidney injury; Electronic alert; Electronic health records; Sniffer