Background: Albumin 25% has been studied and has demonstrated benefit in a limited number of patient populations. The use of albumin 25% is associated with higher costs compared with crystalloid therapy. The aim of this study was to describe the prescribing practices of albumin 25% at a tertiary-care medical center and identify opportunities for restriction criteria related to its use to help generate cost savings. Methods: This evaluation was a retrospective, noninterventional, descriptive study of albumin 25% use between June 2015 and February 2016. Inclusion criteria consisted of patients ≥18 years old and who received at least one dose of albumin 25% while admitted to a Cleveland Clinic main campus intensive care unit (ICU). Inclusion was restricted to 150 randomly selected patients. Results: A total of 539 albumin 25% orders were placed for the 150 included patients. The cardiovascular ICU more frequently prescribed albumin 25% compared with the medical, surgical, neurosciences, and coronary ICUs (51% vs 23% vs 11% vs 9% vs 6%, respectively). Although the cardiovascular surgery ICU most frequently prescribed albumin 25% compared with other ICUs, the medical ICU prescribed a larger total quantity of albumin 25% compared with the cardiovascular, surgical, neurosciences, and coronary ICUs (8705 g vs 7275 g vs 3205 g vs 2162 g vs 625 g, respectively). The majority of patients (61%) did not have an indication listed for albumin 25% use and only 9% of patients were prescribed for indications supported by primary literature. Of the patients prescribed albumin for other indications not supported by primary literature (30%), the most common reasons for albumin 25% were hypotension, acute kidney injury, and volume resuscitation. The median cost per patient of albumin 25% was $417 with a total cost of $122 164 for the cohort. Only 19% of the total cost aligned with dosing regimens evaluated in primary literature. Conclusion: Prescribing patterns of albumin 25% at a tertiary academic medical center do not align with indications supported by primary literature. These findings identified a major opportunity for prescriber education and implementation of restriction criteria to target cost savings.
FinferSBellomoRBoyceNFrenchJMyburghJNortonR; SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350(22):2247-2256.
2.
CaironiPTognoniGMassonS, et al. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med. 2014;370(15):1412-1421.
3.
CharlesAPurtillMDickinsonS, et al. Albumin use guidelines and outcome in a surgical intensive care unit. Arch Surg. 2008;143(10):935-939; discussion 939.
4.
RhodesAEvansLEAlhazzaniW, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304-377.
5.
American Thoracic Society. Evidence-based colloid use in the critically ill: American Thoracic Society Consensus Statement. Am J Respir Crit Care Med. 2004;170(11):1247-1259.
6.
ConnollyESJrRabinsteinAACarhuapomaJR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43(6):1711-1737.
7.
RunyonBA.Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013;57(4):1651-1653.
8.
Van der SandeFMLuikAJKoomanJPVerstappenVLeunissenKM.Effect of intravenous fluids on blood pressure course during hemodialysis in hypotensive-prone patients. J Am Soc Nephrol. 2000;11(3):550-555.
9.
Redbook Online [online database]. Greenwood Village, CO: Truven Health Analytics; 2018.
10.
YimJMVermeulenLCErstadBLMatuszewskiKABurnettDAVlassesPH.Albumin and nonprotein colloid solution use in US academic health centers. Arch Intern Med. 1995;155(22):2450-2455.
11.
GalesBJErstadBL.Albumin audit results and guidelines for use. J Pharm Technol. 1992;8(3):125-129.
12.
AronsonSNisbetPBunkeM.Fluid resuscitation practices in cardiac surgery patients in the USA: a survey of health care providers. Perioper Med. 2017;6:15.
13.
AngusDCDeutschmanCSHallJBWilsonKCMunroCLHillNS.Choosing wisely(R) in critical care: maximizing value in the intensive care unit. Crit Care Med. 2014;42(11):2437-2438.
14.
AltawalbehSMSaulMISeybertALThorpeJMKane-GillSL.Intensive care unit drug costs in the context of total hospital drug expenditures with suggestions for targeted cost containment efforts. J Crit Care. 2018;44:77-81.
15.
MalbrainMVan RegenmortelNSaugelB, et al. Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy. Ann Intensive Care. 2018;8(1):66.
16.
DebrixICombeauDStephanFBenomarABeckerA.Clinical practice guidelines for the use of albumin: results of a drug use evaluation in a Paris hospital. Tenon Hospital Paris. Pharm World Sci. 1999;21(1):11-16.
17.
MartelliAStradaPCaglianiIBrambillaG.Guidelines for the clinical use of albumin: comparison of use in two Italian hospitals and a third hospital without guidelines. Curr Ther Res Clin Exp. 2003;64(9):676-684.
18.
RabinJMeyenburgTLoweryAVRouseMGammieJSHerrD.Restricted albumin utilization is safe and cost effective in a cardiac surgery intensive care unit. Ann Thorac Surg. 2017;104(1):42-48.
19.
NiazkhaniZPirnejadHBergMAartsJ.The impact of computerized provider order entry systems on inpatient clinical workflow: a literature review. J Am Med Inform Assoc. 2009;16(4):539-549.
20.
BaysariMTLehnbomECLiLHargreavesADayROWestbrookJI.The effectiveness of information technology to improve antimicrobial prescribing in hospitals: a systematic review and meta-analysis. Int J Med Inform. 2016;92:15-34.
