ArticleApplied clinical informatics2025
Effect of Tiered Implementation of Clinical Decision Support System for Acute Kidney Injury and Nephrotoxin Exposure in Cardiac Surgery Patients.
Article in Applied clinical informatics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Assessing Medication CDS Usability: Pilot Results from 10 Outpatient Clinics.Applied clinical informatics · 2025Article
- ORAKLE: Optimal Risk prediction for mAke30 in patients with sepsis associated AKI using deep LEarning.Critical care (London, England) · 2025Article
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Authors and funding
18 authors.
Funding
Abstract
backgroundNephrotoxin exposure may worsen kidney injury and impair kidney recovery if continued in patients with acute kidney injury (AKI).
objectivesThis study aimed to determine if tiered implementation of a clinical decision support system (CDSS) would reduce nephrotoxin use in cardiac surgery patients with AKI.
methodsWe assessed patients admitted to the cardiac surgery intensive care unit at a tertiary care center from January 2020 to December 2021, and August 2022 to September 2023. A passive electronic AKI alert was activated in July 2020, followed by an electronic nephrotoxin alert in March 2023. In this alert, active nephrotoxic medication orders resulted in a passive alert, whereas new orders were met with an interruptive alert. Primary outcome was discontinuation of nephrotoxic medications within 30 hours after AKI. Secondary outcomes included AKI-specific clinical actions, determined through modified Delphi process and patient-centered outcomes. We compared all outcomes across five separate eras, divided based on the tiered implementation of these alerts.
resultsA total of 503 patients met inclusion criteria. Of 114 patients who received nephrotoxins before AKI, nephrotoxins were discontinued after AKI in 6 (25%) patients in pre AKI-alert era, 8 (33%) patients in post AKI-alert era, 7 (35%) patients in AKI-alert long-term follow up era, 7 (35%) patients in pre nephrotoxin-alert era, and 14 (54%) patients in post nephrotoxin-alert era (
conclusionTiered implementation of CDSS for recognition of AKI and nephrotoxin exposure resulted in a progressive improvement in the discontinuation of nephrotoxins.
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