Abstract: FR-PO286
Communication of Hyponatremia and Outcomes
Session Information
- Fluid and Electrolytes: Clinical
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid and Electrolytes
- 902 Fluid and Electrolytes: Clinical
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
- Srivatana, Vesh, The Rogosin Institute, New York, New York, United States
- Oromendia, Clara, Weill Cornell Medicine, New York, New York, United States
- Tsai, Stephanie, Weill Cornell Medicine, New York, New York, United States
Background
Prior literature documents the prognostic importance of hyponatremia but 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 important clinical outcomes.
Methods
With IRB approval, we conducted 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 index hospitalization. Discharge summaries were reviewed for mention of hyponatremia; charts were reviewed for pertinent clinical data. 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
Hyponatremia was mentioned in 34% of 127 discharge summaries; patients with communicated hyponatremia were older (mean 72 vs 63 years; p=0.003) and had lower nadir (125 vs 128 mEq/L; p<0.001) and discharge sodium (132 vs 135 mEq/L, p=0.002). Communication was associated with diagnosis of hyponatremia within 24 hours of admission (p=0.006) and admission to general medicine (47% communicated) versus other hospital service (27%) (p=0.02). The cause of hyponatremia was more often SIADH (p<0.001) or hypovolemia (p=0.005) in the communication group. Communication of hyponatremia was not associated with improved one-year mortality, readmission or readmission with hyponatremia. Patients with communicated hyponatremia were less likely to follow up with outpatient providers in our system (60% vs. 81%, p=0.03); of those who followed up in our system, hyponatremia was mentioned in an outpatient provider’s note only twice.
Conclusion
Our results suggest that hyponatremia is infrequently communicated to outpatient providers. Higher rates of communication were associated with severity and timing of hyponatremia and hospital service. The lower rate of follow up in patients with communicated hyponatremia and outpatient providers’ response may explain the lack of difference in clinically important outcomes. Alternatively, communication may be less for patients planning to follow up internally.