Abstract: FR-PO660
Leveraging Electronic Medical Records to Expedite Hyponatremia Management
Session Information
- Fluid and Electrolytes: Clinical - Potassium, Sodium, Water
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid and Electrolytes
- 902 Fluid and Electrolytes: Clinical
Authors
- Sosa, Marie A., University of Miami Miller School of Medicine, Miami, Florida, United States
- Suarez, Maritza M., University of Miami, Miami, Florida, United States
- Seo, David, University of Miami Health System, Miami, Florida, United States
Background
Hyponatremia is defined as serum sodium (Na) ≤135 mmol/L[1]; values ≤125 mmol/L are considered severe. Guidelines suggest Na correction should not exceed 6–8 mmol/L in 24 hours for either acute or chronic hyponatremia, regardless of clinical presentation[6,7]. We analyze the impact of electronic medical record (EMR) alerts to improve the diagnosis of hyponatremia, expedite appropriate management and prevent errors; this has never been described in the literature.
Methods
2-cohort retrospective chart review conducted on inpatients before and after the implementation of two novel alerts. The first alert informed the physician of severe hyponatremia. The second alert displayed for nurses when the Na rose more than 1.5 mmol/L for two consecutive Na, prompting them to contact the provider.
Cohort 1 comprised all inpatients at UHealth Tower in the 3 months before the alert’s implementation. Data was collected for patients experiencing at least one Na of ≤125, and included pertinent blood and urine levels, as well as patterns of physician response. Cohort 2 comprised every patient who provoked a BPA in the 3-month period after go-live.
Using the Mann-Whitney test and Fisher’s Exact test for data analysis, primary endpoints were the percent of patients treated for hyponatremia, percent whose Na was normalized, and overcorrection difference. Secondary endpoints included time to intervention and treatment types.
Results
41 patients had a Na ≤125 in cohort 1 vs 5 patients in cohort 2 (p<0.05). Na overcorrection was not seen in cohort 2; and was 9% in cohort 1 (p=1). 85% in cohort 1 received treatment for hyponatremia vs 80% in cohort 2. Na returned to normal in 75% of cohort 1 vs 40% in cohort 2, which could be due to the small sample size. Faster treatment intervention was seen in cohort 2: 76 mins vs. 24 mins (p=0.2798). Treatments in both cohorts primarily comprised normal saline and fluid restriction.
Conclusion
The implementation of EMR alerts significantly reduce the incidence of severe hyponatremia and may improve response provider response time, with lower overcorrection rates. These unique alerts, geared to assist in the timely management of hyponatremia, could be expanded to other tests and conditions. A follow-up study to explore standardizing management is ongoing.