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The following is a summary of “Feasibility of emergency department observation units in the management of mild to moderate hyponatremia,” published in the June 2024 issue of Emergency Medicine by Taha, et al.

For a study, researchers sought to assess the feasibility of managing patients with hyponatremia under outpatient observation in an academic medical center and compare outcomes between those managed in an emergency department observation unit (EDOU) and non-observation unit (NOU) inpatient beds.

They conducted a retrospective cohort study spanning 27 months, involving patients in emergency departments diagnosed with mild (130–135 mmol/L) to moderate (121–129 mmol/L) hyponatremia across four hospitals within a large urban academic medical center. Patients were managed under an admit-to-observation order and were categorized based on observation settings: EDOU or NOU. Severe hyponatremia (≤120 mmol/L) cases were excluded. Primary outcomes included inpatient admit rate, length of stay (LOS), total direct cost, rate of adverse events, and 30-day recidivism.

A total of 188 patients were included as observation patients, with 64 managed in the EDOU (mean age 74.0 years, 70.3% female) and 124 in the NOU (mean age 71.5 years, 64.5% female). Patient demographics, presenting complaints, comorbidities, and medication histories were similar between groups. Initial and final sodium levels were comparable: EDOU (125.1 to 132.6 mmol/L) vs NOU (123.5 to 132.0 mmol/L). However, significant differences were observed in outcomes between settings: EDOU demonstrated lower observation to inpatient admit rate (28.1% vs 37.9%, adjusted effect 0.70), shorter LOS (EDOU 19.2 hours vs NOU 31.9 hours; adjusted effect −10.5 hours), and lower total direct cost ($1,230 vs $1,531; adjusted effect -$167). EDOU also exhibited faster sodium correction rates (EDOU 0.44 mmol/L/h vs NOU 0.24 mmol/L/h; adjusted effect 0.15 mmol/L/h), with similar 30-day recidivism rates (EDOU 13% vs NOU 15%). There were no deaths or intensive care unit admissions during the index visit.

Managing selected patients with hyponatremia under observation status, particularly in the EDOU setting, was feasible and associated with lower admission rates, shorter hospital stays, and reduced costs without compromising clinical outcomes. The findings suggested that optimizing care pathways for patients with hyponatremia in the ED can enhance efficiency and resource utilization while maintaining patient safety and quality of care.

Reference: sciencedirect.com/science/article/abs/pii/S0735675724001050