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Albumin and Nonprotein Colloid Solution Use in US Academic Health Centers

Albumin and Nonprotein Colloid Solution Use in US Academic Health Centers Abstract Background: Crystalloids, nonprotein colloids (NPCs), and albumin are used for many indications. The use of the least costly agent in situations where these products are clinically interchangeable can reduce health care costs. Objectives: To characterize the prescribing of albumin and NPC. To evaluate the appropriateness and cost implications of their use. Methods: An observational study conducted in 15 academic health centers from April 11 through May 6, 1994, to assess the appropriateness of albumin and NPC use, based on "model" consensus-derived indication guidelines. Results: A total of 969 case report forms were evaluated. Albumin and NPCs were administered in 83% and 17% of the cases, respectively. Albumin and NPCs were administered mostly in the intensive care (50%) or operating room (31%) settings. The most common prescribers of these products were surgeons (45%) and anesthesiologists (20%). In 87% of cases, albumin or NPC was administered to reach a defined end point (eg, to achieve a target physiological state or to resolve a pathophysiological condition). Only one albumin recipient experienced an adverse event; no adverse events were noted with NPC administration. Approximately $203 000 was spent on albumin and NPC therapy for the 969 cases; $49 702 (24%) was spent on appropriate administrations, $124 939 (62%) on inappropriate administrations, and $28 014 (14%) on unevaluated indications. Conclusions: Evaluated against model guidelines, most of the albumin and NPC use in the study was found to be inappropriate. The need for institutions to define and implement guidelines that focus on the cost-efficient use of these agents is recommended in an increasingly cost-conscious health care environment.(Arch Intern Med. 1995;155:2450-2455) References 1. Weaver DW, Ledgerwood AM, Lucas CE, Higgins R, Bouwman DL, Johnson SD. Pulmonary effects of albumin resuscitation for severe hypovolemic shock. Arch Surg . 1978;113:387-392.Crossref 2. Moss GS, Lowe RJ, Jilek J, Levine HD. Colloid or crystalloid in the resuscitation of hemorrhagic shock: a controlled clinical trial. Surgery . 1981;89:434-438. 3. Marelli D, Paul A, Samson R, Edgell D, Angood P, Chiu RCJ. Does the addition of albumin to the prime solution in cardiopulmonary bypass affect clinical outcome? J Thorac Cardiovasc Surg . 1989;98:751-756. 4. Lowe RJ, Moss GS, Jilek J, Levine HD. Crystalloid vs colloid in the etiology of pulmonary failure after trauma: a randomized trial in man. Surgery . 1977;81: 676-683. 5. Zetterström H. Albumin treatment following major surgery, II: effects on postoperative lung function and circulatory adaptation. Acta Anaesthesiol Scand . 1981;25:133-141.Crossref 6. Fassio E, Terg R, Landeira G, et al. Paracentesis with dextran 70 vs paracentesis with albumin in cirrhosis with tense ascites. J Hepatol . 1992;14:310-316.Crossref 7. Palanzo DA, Parr GVS, Bull AP, Williams DR, O'Neill MJ, Waldhausen JA. Hetastarch as a prime for cardiopulmonary bypass. Ann Thorac Surg . 1982; 34:680-683.Crossref 8. Sade RM, Stroud MR, Crawford FA, Kratz JM, Dearing JP, Bartles DM. A prospective randomized study of hydroxyethyl starch, albumin, and lactated Ringer's solution as priming fluid for cardiopulmonary bypass. J Thorac Cardiovasc Surg . 1985;89:713-722. 9. Alexander MR, Ambre JJ, Liskow BI, Trost DC. Therapeutic use of albumin. JAMA . 1979;241:2527-2529.Crossref 10. Favaretti C, Selle V, Marcolongo A, Orsini A. The appropriateness of human albumin use in the hospital of Padova, Italy. Qual Assur Health Care . 1993;5: 49-55.Crossref 11. Stumpf JL, Lechner JL, Ryan ML. Use of albumin in a university hospital: the value of targeted physician intervention. DICP Ann Pharmacother . 1991;25: 239-243. 12. Sgouris JT, Rene A, eds. Proceedings of the Workshop on Albumin, 1975 . Bethesda, Md: National Heart and Lung Institute; 1976. US Dept of Health, Education, and Welfare publication NIH 76-925. 13. Vermeulen LC, Ratko TA, Erstad BL, Brecher ME, Matuszewski KA, for the members of the UHC Consensus Exercise on the Use of Albumin, Nonprotein Colloid, and Crystalloid Solutions. A paradigm for consensus: the University Hospital Consortium guidelines for the use of albumin, nonprotein colloid, and crystalloid solutions. Arch Intern Med . 1995;155:373-379.Crossref 14. Kapiotis S, Quehenberger P, Eichler H, et al. Effect of hydroxyethyl starch on the activity of blood coagulation and fibrinolysis in healthy volunteers: comparison with albumin. Crit Care Med . 1994;22:606-612.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Albumin and Nonprotein Colloid Solution Use in US Academic Health Centers

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References (18)

Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430220110012
Publisher site
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Abstract

Abstract Background: Crystalloids, nonprotein colloids (NPCs), and albumin are used for many indications. The use of the least costly agent in situations where these products are clinically interchangeable can reduce health care costs. Objectives: To characterize the prescribing of albumin and NPC. To evaluate the appropriateness and cost implications of their use. Methods: An observational study conducted in 15 academic health centers from April 11 through May 6, 1994, to assess the appropriateness of albumin and NPC use, based on "model" consensus-derived indication guidelines. Results: A total of 969 case report forms were evaluated. Albumin and NPCs were administered in 83% and 17% of the cases, respectively. Albumin and NPCs were administered mostly in the intensive care (50%) or operating room (31%) settings. The most common prescribers of these products were surgeons (45%) and anesthesiologists (20%). In 87% of cases, albumin or NPC was administered to reach a defined end point (eg, to achieve a target physiological state or to resolve a pathophysiological condition). Only one albumin recipient experienced an adverse event; no adverse events were noted with NPC administration. Approximately $203 000 was spent on albumin and NPC therapy for the 969 cases; $49 702 (24%) was spent on appropriate administrations, $124 939 (62%) on inappropriate administrations, and $28 014 (14%) on unevaluated indications. Conclusions: Evaluated against model guidelines, most of the albumin and NPC use in the study was found to be inappropriate. The need for institutions to define and implement guidelines that focus on the cost-efficient use of these agents is recommended in an increasingly cost-conscious health care environment.(Arch Intern Med. 1995;155:2450-2455) References 1. Weaver DW, Ledgerwood AM, Lucas CE, Higgins R, Bouwman DL, Johnson SD. Pulmonary effects of albumin resuscitation for severe hypovolemic shock. Arch Surg . 1978;113:387-392.Crossref 2. Moss GS, Lowe RJ, Jilek J, Levine HD. Colloid or crystalloid in the resuscitation of hemorrhagic shock: a controlled clinical trial. Surgery . 1981;89:434-438. 3. Marelli D, Paul A, Samson R, Edgell D, Angood P, Chiu RCJ. Does the addition of albumin to the prime solution in cardiopulmonary bypass affect clinical outcome? J Thorac Cardiovasc Surg . 1989;98:751-756. 4. Lowe RJ, Moss GS, Jilek J, Levine HD. Crystalloid vs colloid in the etiology of pulmonary failure after trauma: a randomized trial in man. Surgery . 1977;81: 676-683. 5. Zetterström H. Albumin treatment following major surgery, II: effects on postoperative lung function and circulatory adaptation. Acta Anaesthesiol Scand . 1981;25:133-141.Crossref 6. Fassio E, Terg R, Landeira G, et al. Paracentesis with dextran 70 vs paracentesis with albumin in cirrhosis with tense ascites. J Hepatol . 1992;14:310-316.Crossref 7. Palanzo DA, Parr GVS, Bull AP, Williams DR, O'Neill MJ, Waldhausen JA. Hetastarch as a prime for cardiopulmonary bypass. Ann Thorac Surg . 1982; 34:680-683.Crossref 8. Sade RM, Stroud MR, Crawford FA, Kratz JM, Dearing JP, Bartles DM. A prospective randomized study of hydroxyethyl starch, albumin, and lactated Ringer's solution as priming fluid for cardiopulmonary bypass. J Thorac Cardiovasc Surg . 1985;89:713-722. 9. Alexander MR, Ambre JJ, Liskow BI, Trost DC. Therapeutic use of albumin. JAMA . 1979;241:2527-2529.Crossref 10. Favaretti C, Selle V, Marcolongo A, Orsini A. The appropriateness of human albumin use in the hospital of Padova, Italy. Qual Assur Health Care . 1993;5: 49-55.Crossref 11. Stumpf JL, Lechner JL, Ryan ML. Use of albumin in a university hospital: the value of targeted physician intervention. DICP Ann Pharmacother . 1991;25: 239-243. 12. Sgouris JT, Rene A, eds. Proceedings of the Workshop on Albumin, 1975 . Bethesda, Md: National Heart and Lung Institute; 1976. US Dept of Health, Education, and Welfare publication NIH 76-925. 13. Vermeulen LC, Ratko TA, Erstad BL, Brecher ME, Matuszewski KA, for the members of the UHC Consensus Exercise on the Use of Albumin, Nonprotein Colloid, and Crystalloid Solutions. A paradigm for consensus: the University Hospital Consortium guidelines for the use of albumin, nonprotein colloid, and crystalloid solutions. Arch Intern Med . 1995;155:373-379.Crossref 14. Kapiotis S, Quehenberger P, Eichler H, et al. Effect of hydroxyethyl starch on the activity of blood coagulation and fibrinolysis in healthy volunteers: comparison with albumin. Crit Care Med . 1994;22:606-612.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Dec 11, 1995

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