186: IMPLEMENTATION OF A CRITERIA-BASED ALGORITHM FOR ALBUMIN UTILIZATION FOLLOWING CARDIAC SURGERY

Abstract

Introduction: Although there is ample evidence supporting goal-directed fluid therapy during the perioperative period in cardiac surgical patients, there is inconsistent data on the fluid of choice. Existing literature has shown conflicting results between crystalloids vs. colloids (specifically albumin), creating ambiguity regarding albumin’s safety, efficacy, and place in therapy. The goal of this study was to develop and implement a criteria-based algorithm for albumin utilization following cardiac surgery and analyze its ability to standardize quality of care, enhance appropriateness of albumin utilization, and optimize documentation. Methods: The implemented process strategy incorporated a multi-phase approach: (1) criteria-based albumin algorithm implementation; (2) provider education; and (3) enhancements to the electronic medical record software to facilitate accurate documentation. All adult cardiac surgery patients who received postoperative albumin during the following periods were included: provider-driven prescribing (retrospective control, 4 months) versus criteria-based prescribing per algorithm (prospective study cohort, 4 months). The primary objective of the study was to evaluate the impact of this intervention on albumin utilization/appropriateness and quality of care (ICU length of stay, ventilator days, vasopressor use, and Hi-Flow/BIPAP post-extubation, dialysis requirement, and blood product transfusion/FFP). Secondary endpoints included the accuracy of albumin utilization documentation following enhancements to the electronic medical record software. Results: Following implementation, per-patient albumin vial requirements (5.27 vs. 4.03, p=0.67) and appropriateness of albumin utilization was maintained between groups (98% versus 95%, p=0.13). All quality of care metrics were similar between the groups. The accuracy of albumin utilization documentation demonstrated a statistically significant increase of 8% (89% vs 97% p=0.0003) following criteria-based algorithm implementation. Safety outcomes of mortality and incidence of adverse events were similar between cohorts. Conclusions: Development and implementation of a criteria-based algorithm to drive albumin utilization in postoperative cardiac surgery patients is safe and feasible.