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Kidney Week

Abstract: FR-PO964

Influence of Communication of Hyponatremia on Outcomes

Session Information

  • Patient Safety
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Patient Safety

  • 1501 Patient Safety

Authors

  • Salline, Kirsten, Weill Cornell Medical College, New York, New York, United States
  • Silberzweig, Jeffrey I., The Rogosin Institute, New York, New York, United States
  • Tsai, Stephanie, Weill Cornell Medical College, New York, New York, United States
  • Oromendia, Clara, Weill Cornell Medical College, New York, New York, United States
  • Srivatana, Vesh, The Rogosin Institute, New York, New York, United States
  • Hildick-Smith, Gordon, Weill Cornell Medical College, New York, New York, United States
Background

Despite the growing body of literature documenting the prognostic importance of hyponatremia, it is commonly treated as a peripheral issue during hospital admissions. We seek to quantify the degree to which hyponatremia is reported to outpatient providers and to evaluate factors associated with communication and associations between communication and standard outcome measures.

Methods

With IRB approval, we designed a retrospective cohort study of patients admitted to the Weill Cornell Campus of the New York-Presbyterian Hospital in January 2014 with corrected serum sodium <130 mEq/L who survived the hospitalization. Discharge summaries were manually reviewed for mention of hyponatremia; charts were reviewed for pertinent information. Patients who did and did not have hyponatremia mentioned in the discharge summary were compared using chi-square (or Fisher’s Exact) and Kruskal-Wallis tests for categorical and continuous variables, respectively. Statistical significance was determined be at the 0.05 alpha level.

Results

Of 101 patients, hyponatremia was mentioned in discharge summaries in 37%. Patients with communicated hyponatremia were older (mean 77 vs. 66; p=0.004), and there was a non-significant trend towards Caucasian race (57% vs. 38% p=0.095), other demographic features did not differ. Nadir sodium (125.3 vs 127.3 mEq/L; p=0.001), and discharge sodium (132.2 vs. 134.7 mEq/L mEq/L, p=0.10) were lower for the group with communication. Mean duration of hospitalization was shorter (12 vs. 21 days, p=0.008). Communication of hyponatremia was not associated with one-year mortality, readmissions or readmissions with hyponatremia. Differences in subsequent outpatient providers’ assessment of sodium levels were not significant (60% vs. 49%; n=50, p=0.665). Only 2 patients had hyponatremia labeled as a problem in the encounter note; in just one of these was it also mentioned in the discharge summary.

Conclusion

Despite its prognostic significance, our results suggest that hyponatremia is infrequently communicated to outpatient providers. Higher rates of communication were associated with severity of hyponatremia and shorter hospital stay. A lack of specific outpatient provider response to hyponatremia may explain the lack of association between communication of hyponatremia and outcome measures.

Funding

  • Clinical Revenue Support