Establishing a hospital transfusion management system promotes appropriate clinical use of human albumin in Japan: a nationwide retrospective study

Abstract

BackgroundDespite international recommendations to establish hospital transfusion management systems to promote appropriate use of blood products, the general efficacy of establishing such systems has not been proven. This study aimed to validate the effect of establishing such systems for promoting the appropriate use of human albumin.MethodsIn this retrospective observational study, we used a Japanese Diagnosis Procedure Combination (DPC) database from fiscal year 2012 to 2016, which included inpatient records from approximately 1200 hospitals for payment processes in the national medical insurance system. From this existing database, containing approximately 8 million inpatient records per year, we selected patients with emergency due to “bleeding,” “sepsis,” and “burn injury,” by using the International Classification of Diseases and Injuries 10th revision (ICD-10) codes, and hospitals that had one or more patients for each disease group in each fiscal year. We conducted multivariable logistic regression analysis to estimate the relationship between human albumin administration and the state of the hospital transfusion management system. We evaluated temporal trends of mortality rate and length of stay as an indicator of care quality.ResultsOverall, 139,853 eligible patients admitted to 682 hospitals were selected. The results of the multivariable logistic regression analysis show that patients who were admitted to hospitals with an established hospital transfusion department introducing good practice criteria of blood products were less likely to be administered human albumin compared with those who were admitted to hospitals not introducing it, by approximately 30% for each of the three disease groups; adjusted odds ratios (95% confidential intervals) were 0.70 (0.59–0.83), 0.75 (0.69–0.81), and 0.71 (0.58–0.87) in the “bleeding,” “sepsis,” and “burn injury” groups, respectively. The temporal trends evaluation shows that there were no increasing trends of mortality rate and average length of stay against decreasing trends of human albumin administration in any disease groups.ConclusionsEstablishing a hospital transfusion department responsible for promoting appropriate clinical use of blood products could reduce human albumin administration for critically ill patients without loss of care quality. These findings provide support for policy makers and hospital managers to consider establishing such systems.

Expert consensus on the use of human serum albumin in critically ill patients

“…There have not been any RCTs comparing the efficacy and safety of different concentrations of HSA solutions for fluid resuscitation in patients with sepsis. However, in published large-scale RCTs, low-(4% or 5%) and highconcentration (20% or 25%) HSA solutions have been used as resuscitation fluids, and no serious adverse events have been reported, [8][9][10][11][12][13][14][15][16] confirming that low-and highconcentration HSA solutions are safe in patients with sepsis. Different concentrations of HSA were used in different trials: 4% albumin was used in the SAFE and RASP trials, and 20% albumin was used in the ALBIOS trial.…”

“…In clinical practice, guidelines and consensus are lacking regarding the selection of HSA concentration, the timing of administration, dosage, and target concentration. Inappropriate use of HSA will cause adverse effects and increase medical costs inevitably, whereas guidance from clinical pharmacists or hospital standards can help reduce inappropriate HSA use by 30% and decrease medical costs without affecting patient prognosis [12] . To further strengthen the standardized application of HSA in critically ill patients and achieve optimal clinical outcomes, the Chinese Society of Critical Care Medicine convened a panel of relevant experts who reviewed and summarized data on the clinical use of HSA, outlined 11 relevant clinical problems, and formulated the “Expert Consensus on the Use of Human Serum Albumin in Critically Ill Patients” using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.…”

Getting hit by the bus around the world – a global perspective on goal directed treatment of massive hemorrhage in trauma

“…introduction of a transfusion protocol, led to savings of economic resources without impairing the outcome. Transfusion protocols were implemented in 66% of the included hospitals [50]. Similar numbers are presented by a survey of the Japanese Ministry of Health on the use of blood products, which reported that 64% of all hospitals follow good practice criteria [51].…”

Reducing Human Album Solution Use in the Pediatric Intensive Care Unit

“…According to a recent study using Japanese nationwide inpatient record data, patients admitted to hospitals with a transfusion management system, where the transfusion department stores and dispenses albumin and promotes appropriate albumin use, were less likely to receive albumin than patients admitted to hospitals without such a system. 17 However, the transfusion management system’s impact on albumin use in the ICU had not been elucidated. Our results indicate that albumin stock prohibition on the floor, rather than albumin management by the transfusion department per se , is the key driver in reducing albumin use.…”