title: Association between e-alert implementation for detection of acute kidney injury and outcomes: a systematic review.
abstract: Electronic alerts (e-alerts) for acute kidney injury (AKI) in hospitalized patients are increasingly being implemented; however, their impact on outcomes remains uncertain.
  
  
  
  We performed a systematic review. Electronic databases and grey literature were searched for original studies published between 1990 and 2016. Randomized, quasi-randomized, observational and before-and-after studies that included hospitalized patients, implemented e-alerts for AKI and described their impact on one of care processes, patient-centred outcomes or resource utilization measures were included.
  
  
  
  Our search yielded six studies ( n  = 10 165 patients). E-alerts were generally automated, triggered through electronic health records and not linked to clinical decision support. In pooled analysis, e-alerts did not improve mortality [odds ratio (OR) 1.05; 95% confidence intervals (CI), 0.84-1.31; n  = 3 studies; n  = 3425 patients; I 2  =   0%] or reduce renal replacement therapy (RRT) use (OR 1.20; 95% CI, 0.91-1.57; n  = 2 studies; n  = 3236 patients; I 2  =   0%). Isolated studies reported improvements in selected care processes. Pooled analysis found no significant differences in prescribed fluid therapy.
  
  
  
  In the available studies, e-alerts for AKI do not improve survival or reduce RRT utilization. The impact of e-alerts on processes of care was variable. Additional research is needed to understand those aspects of e-alerts that are most likely to improve care processes and outcomes.
authors.affiliation: Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lachance
authors.affiliation: Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: Pierre-Marc
authors.initials: PM
authors.lastname: Villeneuve
authors.affiliation: Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: Oleksa G
authors.initials: OG
authors.lastname: Rewa
authors.affiliation: Section Nephrology, Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT, USA.|Veterans Affairs Health Center, West Haven, CT, 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, Derby, UK.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Selby
authors.affiliation: Department of Paediatrics, Faculty of Medicine and Dentistry, Alberta Research Center for Health Evidence (ARCHE), University of Alberta, Edmonton, AB, Canada.
authors.forename: Robin M
authors.initials: RM
authors.lastname: Featherstone
authors.affiliation: Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.|Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000628:therapy; D005440:Fluid Therapy / Q000706:statistics & numerical data*; D006284:Health Plan Implementation; D006801:Humans; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data*; D013685:Telecommunications / Q000706:statistics & numerical data*
keywords: acute kidney injury; clinical decision support; electronic alert; meta-analysis; systematic review