Implementation of a real-time electronic alert based on the rifle criteria for acute kidney injury in ICU patients

Acute kidney injury (AKI) is very common among critically-ill patients and is correlated with significant morbidity and mortality. The RIFLE criteria (an acronym comprising Risk, Injury, Failure, Loss and End-stage kidney disease), were developed by a panel of experts aiming at standardizing the definition of AKI and to subdivide AKI into different categories of severity. However, although these criteria are clear and easy to understand, they are still complex and tabour-intensive, and therefore mostly used in retrospective. The use of an electronic alert based on the RIFLE criteria, which warns the physician in real-time when kidney function is deteriorating can help to implement these criteria in daily clinical practice. In this paper we describe the successful implementation of such an alert system. Not only were there technological barriers to solve; also acceptance of the alert by the end user was of pivotal importance. Further research is currently performed to investigate whether the implementation of real-time electronic RIFLE alerts induce faster therapeutic intervention, and to evaluate the impact of a more timely intervention on improved preservation of kidney function and patients' outcome.