Table 1

Review questions mapped to themes used to analyse the studies

Review questionDefinition of concepts
At which level is the real-time data intended to generate action: what is the digital information designed to change?Micro: patient-level
  • Clinical care and treatment at the patient level.

Meso: organisation/specialty/service/unit management-level
For example,
  • Management of cohorts of renal patients by specialist e.g. pharmacist or renal specialist.

  • Allocation of patients to a particular care pathway or ward.

  • Staffing levels or skill mix.

  • Resource distribution e.g. across diagnostic services or educational support or between harm management and risk assessment interventions.

Macro: population-level
For example,
  • Targeting of interventions at particular populations e.g. primary or secondary care.

  • Population management processes or the range of services that are available across the health and care system.

NB: Some studies report on interventions where impact is intended at multiple levels. These were extracted to the higher level i.e. macro, meso then micro.
What are the interventions and which staff are the targets?Afferent arm (the monitored data item used to trigger a response)
  • Serum creatinine changes.

  • Risk prediction score using composite values (on ‘entry’ identify at risk of AKI before any treatments).

  • Urine output.

  • Nephrotoxin exposure.

Timing (speed at which the digital data available to the responder)
  • Real-time <1 hour.

  • Near real-time <24 hours.

Targeted group
  • Physician.

  • Nurse.

  • Pharmacist.

  • Two or more—multidisciplinary team.

  • Undefined (clinical team).

How integrated is the intervention into workflow?Efferent arm (the alerting mechanism)
  • Interruptive within workflow.

  • Interruptive outside workflow.

  • Non-interruptive within workflow.

  • Non-interruptive outside workflow.

  • Undefined.

Level of digital maturity
Level 1: Stand-alone afferent arm that requires human intervention for efferent mechanism e.g. by sending an email or text to raise an alert.
Level 2: Integrated afferent and efferent arms in a single system with a specific focus e.g. pharmacy medicines management systems.
Level 3: Integrated afferent and efferent arms that link alert data to wider response group across organisation or system but are not integrated into clinical workflow.
Level 4: Integrated afferent and efferent arms that link alert data to wider response group across organisation or system and into clinical workflow.
Level 5: Multi-organisation and cross-sectional (but otherwise same as 4).
Can use of real-time data improve processes of care and outcomes for patients with AKI?Process measure
Measures of specific activity completed used in the study.
Outcome measure
Measures of clinical outcomes or proxies used in the study.
Changes in process or outcome measures as a result of the intervention being studied.
  • AKI, acute kidney injury.