Activation of a Severe Hyponatremia Care Pathway in ICU patients was associated with increased 3% hypertonic saline utilization (49% vs 19%, p<0.001) and lower mortality (6% vs 22%, p<0.001).
Cohort (n=412)
Yes
Does a Severe Hyponatremia Care Pathway improve treatment optimization and clinical outcomes in adult patients with severe hyponatremia?
Implementation of an EHR-integrated care pathway for severe hyponatremia is associated with optimized pharmacologic treatment, reduced ICU length of stay, and lower in-hospital mortality.
Absolute Event Rate: 49% vs 19%
p-value: p=<0.001
Introduction: Severe hyponatremia treatment variability across large health systems makes maintaining an institutional care standard demanding. The primary purpose is to evaluate the impact of a system-wide Severe Hyponatremia Care Pathway integrated into the electronic health record on resource utilization, as measured in 3% hypertonic saline (HTS) utilization in adult patients with severe hyponatremia. Methods: Electronic health record data were used to retrospectively identify patients aged 18 years or older admitted to a hospital within the Yale New Haven Health System between October 1, 2023, and February 28, 2025, who experienced severe hyponatremia, defined as a serum sodium level of < 120 mEq/L. Patients were stratified based on whether the provider activated the Severe Hyponatremia Care Pathway. The primary outcome was the frequency of 3% HTS bolus administrations. Other outcomes include the frequency of desmopressin (DDAVP) and dextrose 5% (D5) administrations. Hospital and intensive care unit (ICU) length of stay (LOS), in-hospital mortality, and disposition were also evaluated. A sub-group analysis for patients admitted to an ICU was performed. Descriptive analyses were reported. Results: Of 412 total patients, 181 (44%) had provider activation of the Severe Hyponatremia Care Pathway (pathway group), and 231 (56%) did not (no-pathway group). ICU patients in the pathway group were more likely to receive 3% HTS (49% vs. 19%, p < 0.001), have shorter ICU LOS (4.8 vs. 7.6 days), and better mortality rates (6% vs. 22%, p< 0.001). Correction agents (DDAVP and D5) had mixed results with pathway patients more likely to receive DDAVP (31% vs 16%, p< 0.001), but D5 more likely for non-pathway patients (32% vs. 22%, p=0.03). Conclusions: While this study has several limitations and barriers, the results suggest that utilizing a health system-based Care Pathway may be associated with optimized pharmacologic treatment, lower in-hospital mortality rates, and shorter hospital and ICU LOS in patients with severe hyponatremia.
O’Rourke et al. (Sun,) conducted a cohort in Severe hyponatremia (n=412). Severe Hyponatremia Care Pathway vs. No pathway activation was evaluated on Frequency of 3% HTS bolus administrations (p=<0.001). Activation of a Severe Hyponatremia Care Pathway in ICU patients was associated with increased 3% hypertonic saline utilization (49% vs 19%, p<0.001) and lower mortality (6% vs 22%, p<0.001).