(1292) Evaluation of Hyponatremia Management Pathway Implementation in a Large Academic Health System

Introduction: Severe Hyponatremia treatment variability across large health systems makes it difficult to establish and maintain an institutional care standard. To address this gap, we implemented a system-wide Care Signature Hyponatremia Pathway integrated into the electronic health record. The pathway was designed to reflect best practices while streamlining diagnostic and therapeutic interventions, including risk stratification, indications for hypertonic saline use, and guidelines for transitioning to alternative therapies. The primary aim was to assess the impact of pathway use on patient outcomes and resource utilization.

Methods: A multidisciplinary team of physicians (critical care, emergency medicine, nephrology, endocrinology), nursing, pharmacy, and hospital administration reviewed literature, guidelines, and internal metrics to draft consensus statements to drive the Pathway development that went into production on October 1, 2023. A retrospective review of patients diagnosed with severe hyponatremia (Na < 120 mEq) between October 1, 2023, and July 30, 2024, was conducted using SlicerDicer. The primary outcomes assessed were in-hospital mortality and use of 3% hypertonic saline between patients receiving pathway vs. non-pathway augmented care.

Results: A total of 239 patients were included. Pathway patients had significantly higher hypertonic saline use than non-pathway patients [44.4% (n=32) vs. 20.1% (n=38); OR 3.37 (95% CI 1.82-6.23, p=0.0001)] as well as a lower mortality rate [9.7% (n=7) vs. 22.7% (n=38); OR 0.30 (95% CI 0.13-0.71, p=0.006)].

Conclusions: Patients with severe hyponatremia managed with the Pathway were more likely to receive hypertonic saline and have lower mortality compared to non-pathway patients. These results suggest that care pathways can improve clinical outcomes. Future adequately powered studies are needed to further evaluate the impact of care pathways on standardization of care as well as short and long-term outcomes and cost-effectiveness.