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Electronic Alerts for Acute Kidney Injury Amelioration (ELAIA-1): a completely electronic, multicentre, randomised controlled trial: design and rationale
  1. Marina Mutter1,
  2. Melissa Martin1,
  3. Yu Yamamoto1,
  4. Aditya Biswas1,
  5. Boian Etropolski1,
  6. Harold Feldman2,
  7. Amit Garg3,
  8. Noah Gourlie4,
  9. Stephen Latham1,
  10. Haiqun Lin1,
  11. Paul M Palevsky5,
  12. Chirag Parikh6,
  13. Erica Moreira1,
  14. Ugochukwu Ugwuowo1,
  15. Francis P Wilson1,7
  1. 1 Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, USA
  2. 2 Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  3. 3 Department of Medcine, University of Western Ontario, London, Ontario, Canada
  4. 4 Baim Institute for Clinical Research, Boston, Massachusetts, USA
  5. 5 Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  6. 6 Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  7. 7 Department of Medicine, Yale University, New Haven, Connecticut, USA
  1. Correspondence to Dr Francis P Wilson; francis.p.wilson{at}yale.edu

Abstract

Introduction Acute kidney injury (AKI) is common among hospitalised patients and under-recognised by providers and yet carries a significant risk of morbidity and mortality. Electronic alerts for AKI have become more common despite a lack of strong evidence of their benefits. We designed a multicentre, randomised, controlled trial to evaluate the effectiveness of AKI alerts. Our aim is to highlight several challenges faced in the design of this trial, which uses electronic screening, enrolment, randomisation, intervention and data collection.

Methods and analysis The design and implementation of an electronic alert system for AKI was a reiterative process involving several challenges and limitations set by the confines of the electronic medical record system. The trial will electronically identify and randomise 6030 adults with AKI at six hospitals over a 1.5–2 year period to usual care versus an electronic alert containing an AKI-specific order set. Our primary outcome will be a composite of AKI progression, inpatient dialysis and inpatient death within 14 days of randomisation. During a 1-month pilot in the medical intensive care unit of Yale New Haven Hospital, we have demonstrated feasibility of automating enrolment and data collection. Feedback from providers exposed to the alerts was used to continually improve alert clarity, user friendliness and alert specificity through refined inclusion and exclusion criteria.

Ethics and dissemination This study has been approved by the appropriate ethics committees for each of our study sites. Our study qualified for a waiver of informed consent as it presents no more than minimal risk and cannot be feasibly conducted in the absence of a waiver. We are committed to open dissemination of our data through clinicaltrials.gov and submission of results to the NIH data sharing repository. Results of our trial will be submitted for publication in a peer-reviewed journal.

Trial registration number NCT02753751; Pre-results.

  • Acute kidney injury
  • acute renal failure
  • electronic health record
  • randomized, alert
  • clinical decision support

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors Substantial contributions to the conception or design of the study: HF, AG, NG, SL, HL, PMP, CP, FPW. Acquisition, analysis or interpretation of data: MMutter, MMartin, YY, AB, BE, HF, AG, SL, HL, PMP, CP, EM, FPW. Drafting or revising the work critically: MMutter, MMartin, YY, AB, BE, HF, AG, NG, SL, HL, PMP, CP, EM, UU, FPW. Final approval of the draft to be published: MMartine, MMutter, YY, AB, BE, HF, AG, NG, SL, HL, PMP, CP, EM, UU, FPW. Agreement to be accountable for all aspects of the work and ensuring that questions related to accuracy or integrity are appropriately investigated and resolved: MMutter, MMartin, YY, AB, BE, HF, AG, NG, SL, HL, PMP, CP, EM, UU, FPW.

  • Funding This research was supported by NIH grants R01DK113191 to FPW and the Yale O’Brien Center P30DK079310.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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