Appl Clin Inform - Development and performance of electronic acute kidney injury triggers to identify pediatric patients at risk for nephrotoxic medication-associated harm.

Tópicos

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Resumo

CKGROUND: Nephrotoxic medication-associated acute kidney injury (NTMx-AKI) is a costly clinical phenomenon and more common than previously recognized. Prior efforts to use technology to identify AKI have focused on detection after renal injury has occurred.OBJECTIVES: Describe an approach and provide a technical framework for the creation of risk-stratifying AKI triggers and the development of an application to manage the AKI trigger data. Report the performance characteristics of those triggers and the refinement process and on the challenges of implementation.METHODS: Initial manual trigger screening guided design of an automated electronic trigger report. A web-based application was designed to alleviate inefficiency and serve as a user interface and central workspace for the project. Performance of the NTMx exposure trigger reports from September 2011 to September 2013 were evaluated using sensitivity (SN), specificity (SP), positive and negative predictive values (PPV, NPV).RESULTS: Automated reports were created to replace manual screening for NTMx-AKI. The initial performance of the NTMx exposure triggers for SN, SP, PPV, and NPV all were =0.78, and increased over the study, with all four measures reaching =0.95 consistently. A web-based application was implemented that simplifies data entry and couriering from the reports, expedites results viewing, and interfaces with an automated data visualization tool. Sociotechnical challenges were logged and reported.CONCLUSION: We have built a risk-stratifying system based on electronic triggers that detects patients at-risk for NTMx-AKI before injury occurs. The performance of the NTMx-exposed reports has neared 100% through iterative optimization. The complexity of the trigger logic and clinical workflows surrounding NTMx-AKI led to a challenging implementation, but one that has been successful from technical, clinical, and quality improvement standpoints. This report summarizes the construction of a trigger-based application, the performance of the triggers, and the challenges uncovered during the design, build, and implementation of the system.

Resumo Limpo

ckground nephrotox medicationassoci acut kidney injuri ntmxaki cost clinic phenomenon common previous recogn prior effort use technolog identifi aki focus detect renal injuri occurredobject describ approach provid technic framework creation riskstratifi aki trigger develop applic manag aki trigger data report perform characterist trigger refin process challeng implementationmethod initi manual trigger screen guid design autom electron trigger report webbas applic design allevi ineffici serv user interfac central workspac project perform ntmx exposur trigger report septemb septemb evalu use sensit sn specif sp posit negat predict valu ppv npvresult autom report creat replac manual screen ntmxaki initi perform ntmx exposur trigger sn sp ppv npv increas studi four measur reach consist webbas applic implement simplifi data entri courier report expedit result view interfac autom data visual tool sociotechn challeng log reportedconclus built riskstratifi system base electron trigger detect patient atrisk ntmxaki injuri occur perform ntmxexpos report near iter optim complex trigger logic clinic workflow surround ntmxaki led challeng implement one success technic clinic qualiti improv standpoint report summar construct triggerbas applic perform trigger challeng uncov design build implement system

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