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Addressing Inpatient Hyponatremia Through Targeted Automatic E-consults: A Pilot Randomized Trial.

Timothy J Judson1, Lowell Lo2, John E Demko2

  • 1Department of Medicine, University of California San Francisco, San Francisco, CA, USA. Timothy.judson@ucsf.edu.

Journal of General Internal Medicine
|October 22, 2024
PubMed
Summary
This summary is machine-generated.

Targeted automatic electronic consultations (TACos) for hyponatremia were feasible and acceptable, often changing patient management. Further research is needed to confirm their impact on clinical outcomes and cost-effectiveness.

Keywords:
acceptabilitye-consultsfeasibilityhyponatremiainpatientpilot trialspecialist consultationtargeted automatic e-consultation

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Area of Science:

  • Nephrology
  • Internal Medicine
  • Health Informatics

Background:

  • Hyponatremia is a common hospital-acquired electrolyte disorder with suboptimal correction rates.
  • Limited nephrologist resources hinder timely diagnosis and treatment of hyponatremia.
  • Targeted automatic electronic consultations (TACos) offer a scalable model for expert nephrology guidance.

Purpose of the Study:

  • To assess the feasibility and acceptability of a TACo intervention for hospitalized patients with hyponatremia.
  • To evaluate the impact of TACos on hyponatremia diagnosis and management.

Main Methods:

  • A single-site, parallel-group cluster randomized trial was conducted.
  • Adult inpatients with hyponatremia were enrolled.
  • Nephrologists provided daily TACos with diagnostic and therapeutic recommendations.

Main Results:

  • 68% of intervention patients benefited from TACos, with a mean of 2.6 e-consults per patient.
  • 78% of physicians reported TACos changed their management, and 83% desired continuation.
  • Clinical outcomes, including hyponatremia resolution, length of stay, readmissions, and costs, were similar between groups.

Conclusions:

  • Inpatient TACos for hyponatremia are feasible and acceptable to clinical teams.
  • TACos frequently influenced hyponatremia diagnosis and management strategies.
  • Further investigation is required to establish the clinical and cost-effectiveness of the TACo model.