ArticleBMJ open2019
Acute kidney injury electronic alerts: mixed methods Normalisation Process Theory evaluation of their implementation into secondary care in England.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Implementation process and acceptability of the electronic community health information system among community health workers in Kenya.Frontiers in health services · 2026Article
- Exploring the Normalisation of Telepsychiatry Practice Among Private Psychiatrists in Australia: A Convergent Mixed Methods Study.International journal of telemedicine and applications · 2025Article
- Article
- Geriatric Assessment in CKD Care: An Implementation Study.Kidney medicine · 2024Article
- Information displays for automated surveillance algorithms of in-hospital patient deterioration: a scoping review.Journal of the American Medical Informatics Association : JAMIA · 2023Article
- Facilitators and Barriers to Interacting With Clinical Decision Support in the ICU: A Mixed-Methods Approach.Critical care explorations · 2023Article
- Can Artificial Intelligence Assist in Delivering Continuous Renal Replacement Therapy?Advances in chronic kidney disease · 2022Review
- Prior to Implementation of Digital Pathology-Assessment of Expectations among Staff by Means of Normalization Process Theory.International journal of environmental research and public health · 2022Article
- Translational framework for implementation evaluation and research: a normalisation process theory coding manual for qualitative research and instrument development.Implementation science : IS · 2022Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveAround one in five emergency hospital admissions are affected by acute kidney injury (AKI). To address poor quality of care in relation to AKI, electronic alerts (e-alerts) are mandated across primary and secondary care in England and Wales. Evidence of the benefit of AKI e-alerts remains conflicting, with at least some uncertainty explained by poor or unclear implementation. The objective of this study was to identify factors relating to implementation, using Normalisation Process Theory (NPT), which promote or inhibit use of AKI e-alerts in secondary care.
designMixed methods combining qualitative (observations, semi-structured interviews) and quantitative (survey) methods. SETTING AND
participantsThree secondary care hospitals in North East England, representing two distinct AKI e-alerting systems. Observations (>44 hours) were conducted in Emergency Assessment Units (EAUs). Semi-structured interviews were conducted with clinicians (n=29) from EAUs, vascular or general surgery or care of the elderly. Qualitative data were supplemented by Normalization MeAsure Development (NoMAD) surveys (n=101). ANALYSIS: Qualitative data were analysed using the NPT framework, with quantitative data analysed descriptively and using χ
resultsParticipants reported familiarity with the AKI e-alerts but that the e-alerts would become more normalised in the future (p<0.001). No single NPT mechanism led to current (un)successful implementation of the e-alerts, but analysis of the underlying subconstructs identified several mechanisms indicative of successful normalisation (internalisation,
conclusionsClinicians recognised the value and importance of AKI e-alerts in their practice, although this was not sufficient for the e-alerts to be routinely engaged with by clinicians. To further normalise the use of AKI e-alerts, there is a need for tailored training on use of the e-alerts and routine feedback to clinicians on the impact that e-alerts have on patient outcomes.
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