Renal Recovery after the Implementation of an Electronic Alert and Biomarker-Guided Kidney-Protection Strategy following Major Surgery.

Background: The facilitation of early recovery of acute kidney injury (AKI) is an important step to improve outcome, particularly because of the limited therapeutic interventions currently available for AKI. The combination of an electronic alert and biomarker-guided kidney-protection strategy implemented in the routine care may have an impact on the incidence of early complete reversal of AKI after major non-cardiac surgery. Methods: We studied 294 patients in two cohorts before (n = 151) and after protocol implementation (n = 143). Data collection required 6 months for each cohort. The kidney-protection protocol included an electronic alert to detect patients who were eligible for urinary biomarker [TIMP2 × IGFBP7]-guided kidney-protection intervention. Intervention was stratified according to three levels of immediate AKI risk: low, moderate, and high. After intervention, postoperative changes in the glomerular filtration rate (eGFR) were identified with a tracking software that included an alert for nephrology consultation if the eGFR had declined by >25% from the preoperative reference value. Primary outcome was early AKI recovery, i.e., the complete reversal of any AKI stage to absence of AKI within the first 7 postoperative days. Results: Protocol implementation significantly increased the recovery of AKI (36/46, 78% compared to control 27/48, 56%, (p = 0.025)) and reduced the length of the ICU stay (p < 0.001). There was no significant difference in the overall incidence of all AKI and moderate and severe AKI in the first 7 postoperative days: 46/143 (32%) and 12/151 (8%) in the protocol implementation group compared to 48/151 (32%) and 18/151 (12%) in the historical control group. Patients with AKI reversal within the first 7 postoperative days had lower in-hospital mortality than patients without AKI reversal. Conclusions: Implementing a combined electronic alert and biomarker-guided kidney-protection strategy in routine care improved early recovery of AKI after major surgery.

[Use of computer applications to support clinical processes. An electronic letter of discharge as resource for DRG-relevant coding]. / Einsatz elektronischer Verfahren zur Okonomisierung von ArbeitsabläufenDer Arztbrief als Hilfsmittel zur DRG-gerechten Diagnosendokumentation.

Not long ago forensic aspects where the major driving force to complete and correct medical documentation. Diagnosis related groups becoming basic data for billing of hospital treatment in Germany now extremely extend the need for complex administrative documentation over-ruling all medical documentary needs. Due to unchanged personnel resources in hospitals and due to a lack of comfortable tools supporting these documentary needs medical personnel in most hospitals is confronted with an annoying effort to fulfill these needs. As a result innumerable hours of working time have to be shifted from patient focused to administrative work. This paper introduces a computer system based on a hospital-wide documentation concept and clinical workflow allowing to derive administrative data straight from medical documents so that redundant documentation and discrepancies between medical and administrative documentation can be avoided.