e-Alerts for AKI Overview NHS Tayside Dr Bill Bartlett Consultant Clinical Scientist, Blood Sciences
RCPE UK Consensus Conference 16-17 th November 2012 Management of acute Kidney injury: the role of fluids, e-alerts and biomarkers. Recognised KDIGO, and NICE in progress. Identified 3 areas requiring greater focus: - • Role of fluid therapy in AKI • The role of e-alerts based on KDIGO criteria • Role of Biomarkers
Elements of an e- alerting process
E-alerts for AKI meeting • July 2013 Derby Royal Infirmary • Th algorithm that was agreed by the meeting • All LIMS suppliers present agreed – algorithm was deliverable – no issues that would delay implementation beyond the industry standard requirements to configure and test the algorithm.
AKI Alerting NHS Tayside Lab System Reporting Outputs Post-reporting processes Flags Paper Reports: with Commentary Clinisys Lab System. Sunquest Ice: - ACB Algorithm Patient Report analysis Electronic Reports: based on AKI Flag. Flags: AKI 1, AKI2, or AKI3 Sunquest ICE: 1 ° & 2 ° Visual Queues Comments Generated Care with non active hyperlinks Ice Mail Clinical Portal/GP systems to Guidance NHS Mail EDT to Primary care: AKI Lists DocMan: Image Telephone: AKI2 and AKI3
Printed report AKI status Not found, AKI1, AKI2 or AKI3 • Commentary depending on stage • Hyperlink given to renal page – Primary Care – Secondary Care – AKI 3 phone renal Reg. • Appends all conventional or electronic reports
ICE REPORTING AND E-ALERTS
Hot Links to guidance within ICE
Visual Queues: Driven by patient report analyser in ICE
No Alert Ice CHI Search No Alert Standard Coloured Banner
CHI Search Extreme Alert: AKI 3 Red Alert Standard Coloured Banner Click on Icon
Click Alert Icon to deal with Appearance of Alert in Report View alert, or see actions Patient banner Red to indicate extreme Alert AKI Stage AKI Comments from Lab System: Will give details of link to guidance or suggest other actions (phone renal)
Alert Levels AKI 1 AKI 2 AKI 3
Add notes Extreme Alert: Add Notes Red Coloured Hyperlink to Background for extreme Extreme Alert Renal Alert AKI Icon Guidance
Extreme Alert: Actions against alert Actions Taken
E-Mail and Alerts: ICE mail and beyond
Alerts Ice mail Ice Mail sent in Response to alert. Can also be forwarded to NHS mail
Alerts Ice mail Ice Mail date and time of alert
Alerts ICE mail High priority alert Link to report Details of Alert
AKI Lists
AKI List
Issues to come back to • Algorithm not fool proof. – Identification of baseline – Catch all disclaimers so as to not to introduce complacency – Dialysis patients • Lots of AKI 1 • GP workflow not based around ICE • NHS Mail issues • 24/7 cover • Granularity in the AKI lists. • ADT Links required
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