University of Cincinnati College of Medicine, Kentucky, United States
Background/Case Studies: There is a gap in the literature in terms of albumin utilization practices. The primary objective of this audit is to determine the proportion of 5% and 25% intravenous albumin infusions meeting a priori appropriateness criteria for indication. Secondary outcomes include determining the patterns of practice surrounding intravenous albumin use: patient demographics, most responsible diagnosis, location at time of order, clinical outcomes of albumin recipients, and types, volumes, and cost of albumin infused.
Study
Design/Methods: We conducted a single center retrospective observational electronic audit of adult inpatients who received one or more units of albumin (5% or 25%) between September 1, 2019-August 31, 2020 at a community hospital. Research ethics board approval was obtained. Utilization data identified through the laboratory information system was independently adjudicated as appropriate acceptable, appropriate may be acceptable, or inappropriate.
Results/Findings: Table 1 outlines the baseline patient characteristics of albumin recipients, procedures performed within 24 hours of the albumin transfusion event, albumin utilization patterns, and appropriateness of indications. This cohort had an in-hospital mortality rate of 38.4%, with an average of 6 days from first dose of albumin to death. The mean length of stay of patients receiving albumin transfusions was 14 days, with a mean intensive care length of stay of 8 days. Conclusions: Based on a lack of or an unacceptable indication provided, 71% of patients were inappropriately transfused. Albumin use deviating from that recommended in the guidelines is likely contributing to increased health care costs and potential patient harm.
Importance of research: There is a gap in the literature in terms of albumin utilization practices which we aim to address through conducting this audit. This audit will provide a timely baseline assessment of current practices and outcomes prior to the release of the International Collaboration for Transfusion Medicine Guidelines (ICTMG) albumin guideline and resultant implementation of clinical practice changes to inform future interventional quality improvement studies.
