Figure 1.

Schematic of the stepped wedge study design. After a 6-month period of baseline data collection, the intervention (hospital-wide AKI e-alert, care bundle, and education program) was sequentially introduced to participating sites across fixed 3-month periods of time until all sites were exposed to the intervention. Data collection occurred at each step of the wedge, including in the postintervention period. The 3-month time period during which a site introduced the intervention, when it was expected not to have reached full effect on outcomes, was considered a transition period and excluded from analyses. All sites had a minimum of one 1-month period of exposure to the intervention after the transition period. The sequence was determined by random number generation, and the order of the hospitals was as follows: (1) Frimley, (2) Bradford, (3) Ashford and St. Peters, (4) Leeds General Infirmary, and (5) Leeds St. James.