Reducing Human Album Solution Use in the Pediatric Intensive Care Unit

Area of Science:

• Pediatric Intensive Care
• Health Services Research
• Quality Improvement

Background:

• Limited evidence supports improved outcomes with 5% human albumin solution (5% albumin) in pediatric intensive care units (PICUs).
• Injudicious use of 5% albumin was identified in the study PICU.
• A need existed to improve healthcare efficiency by reducing 5% albumin administration.

Purpose of the Study:

• To decrease the use of 5% albumin in pediatric patients (≤17 years) in the PICU by 50% within 12 months.
• To enhance healthcare efficiency through targeted interventions.
• To evaluate the impact of interventions on 5% albumin consumption and associated costs.

Main Methods:

• A quality improvement project was implemented in a PICU.
• Statistical process control charts monitored monthly mean 5% albumin volume per PICU admission.
• Interventions included education, feedback, alerts, and ultimately, removal of 5% albumin from inventory.

Main Results:

• Mean 5% albumin use per PICU admission decreased significantly from 48.1 mL to 22.4 mL after the first intervention and 8.3 mL after the second intervention.
• Cost savings of 82% per PICU admission were achieved.
• The reductions in 5% albumin use were sustained for 12 months, with no significant differences in patient characteristics or balancing measures (ventilation and PICU stay length).

Conclusions:

• Stepwise quality improvement interventions are effective in reducing 5% albumin use in PICUs.
• System changes, such as eliminating 5% albumin inventory, are crucial for sustained reduction.
• These interventions improve healthcare efficiency without negatively impacting patient outcomes.