title: Impact of e-alert for detection of acute kidney injury on processes of care and outcomes: protocol for a systematic review and meta-analysis.
abstract: Acute kidney injury (AKI) is a common complication in hospitalised patients. It imposes significant risk for major morbidity and mortality. Moreover, patients suffering an episode of AKI consume considerable health resources. Recently, a number of studies have evaluated the implementation of automated electronic alerts (e-alerts) configured from electronic medical records (EMR) and clinical information systems (CIS) to warn healthcare providers of early or impending AKI in hospitalised patients. The impact of e-alerts on care processes, patient outcomes and health resource use, however, remains uncertain.
  
  
  
  We will perform a systematic review to describe and appraise e-alerts for AKI, and evaluate their impact on processes of care, clinical outcomes and health services use. In consultation with a research librarian, a search strategy will be developed and electronic databases (ie, MEDLINE, EMBASE, CINAHL, Cochrane Library and Inspec via Engineering Village) searched. Selected grey literature sources will also be searched. Search themes will focus on e-alerts and AKI. Citation screening, selection, quality assessment and data abstraction will be performed in duplicate. The primary analysis will be narrative; however, where feasible, pooled analysis will be performed. Each e-alert will be described according to trigger, type of alert, target recipient and degree of intrusiveness. Pooled effect estimates will be described, where applicable.
  
  
  
  Our systematic review will synthesise the literature on the value of e-alerts to detect AKI, and their impact on processes, patient-centred outcomes and resource use, and also identify key knowledge gaps and barriers to implementation. This is a fundamental step in a broader research programme aimed to understand the ideal structure of e-alerts, target population and methods for implementation, to derive benefit. Research ethics approval is not required for this review.
  
  
  
  CRD42016033033.
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lachance
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Pierre-Marc
authors.initials: PM
authors.lastname: Villeneuve
authors.affiliation: Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Francis P
authors.initials: FP
authors.lastname: Wilson
authors.affiliation: Division of Medical Sciences and Graduate Entry Medicine, Centre for Kidney Research and Innovation, University of Nottingham, Nottingham, Nottingham, UK.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Selby
authors.affiliation: Department of Pediatrics, Alberta Research Center for Health Evidence (ARCHE), University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Robin
authors.initials: R
authors.lastname: Featherstone
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Oleksa
authors.initials: O
authors.lastname: Rewa
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000628:therapy; D042241:Early Diagnosis; D057286:Electronic Health Records; D006801:Humans; D015201:Meta-Analysis as Topic; D010043:Outcome and Process Assessment, Health Care; D012107:Research Design; D000078202:Systematic Reviews as Topic
keywords: acute kidney injury; computerized decision support; electronic alerts