• Timothy J Judson, Lowell Lo, John E Demko, Michelle Mourad, Kathleen D Liu, Robert M Wachter, Isaac Lopez, and Sri Lekha Tummalapalli.
• Department of Medicine, University of California San Francisco, San Francisco, CA, USA. Timothy.judson@ucsf.edu.
• J Gen Intern Med. 2024 Oct 22.

BackgroundHyponatremia is the most common electrolyte abnormality in hospitalized patients. Treatment of hyponatremia is associated with improved outcomes, but more than one in three cases of new onset hyponatremia is not corrected by the time of hospital discharge. Nephrologist input may improve the diagnosis and treatment of hyponatremia, but specialist resources are limited. Targeted automatic electronic consultations (TACos) may be one approach to provide expert nephrologist guidance to the workup and management of hyponatremia using a scalable model.ObjectiveEvaluate the feasibility and acceptability of a TACo intervention for hospitalized patients with hyponatremia.DesignSingle-site, parallel-group cluster randomized trial.ParticipantsAdult inpatients with hyponatremia on the hospital medicine service.InterventionsA nephrologist conducted TACos on intervention patients, making diagnostic and therapeutic recommendations daily (if warranted) until discharge or resolution of hyponatremia.Main MeasuresMeasures of feasibility included the number of eligible participants, percentage receiving TACos, number of TACos per participant, and percentage of formal nephrology consults. Acceptability was assessed by a post-intervention survey. Clinical outcomes, including the percentage of hyponatremia cases that resolved by discharge, were also assessed.Key ResultsWe identified 62 patients who met inclusion criteria: 38 in the intervention group and 24 in the control group. A nephrologist determined that 26 of 38 intervention patients (68%) would likely benefit from diagnostic and management recommendations; 67 TACos were performed (mean 2.6 per patient). Fourteen of 18 primary team physicians (78%) reported that the e-consults changed their management, and 15 of 18 (83%) wanted TACOs to continue. Resolution of hyponatremia, length of stay, 30-day readmissions, and costs were similar in the intervention and control groups.ConclusionsInpatient TACos for hyponatremia were feasible and acceptable to primary teams, and frequently led to changes in diagnosis and management. Further studies are needed to determine the impact of the TACo model on clinical outcomes and cost-effectiveness.© 2024. The Author(s).

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