title: Guidelines for the clinical use of albumin: comparison of use in two Italian hospitals and a third hospital without guidelines.
abstract: BACKGROUND
  In the absence of clinical practice guidelines prior to 1999, the consumption of human albumin in the Liguria region of Italy was very high, despite possible adverse effects, limited supply, and significant cost.
  
  
  OBJECTIVE
  The purpose of this study was to assess the impact of comprehensive guidelines on the amount of albumin used in 2 general hospitals and to compare it with that of a third general hospital that did not adopt the guidelines.
  
  
  METHODS
  We analyzed the influence of the guidelines on albumin use in 2 general hospitals (hospitals 1 and 2) in the Liguria region by comparing albumin consumption during the year before the distribution of the guidelines (1999) with consumption in the 2 years after their distribution (2000 and 2001). We compared these data with those of a third general hospital that did not adopt the guidelines (hospital 3). The parameters considered were total consumption of albumin, consumption per bed, consumption per hospital stay, mean time to discharge, expenditure per bed, and mortality rate.
  
  
  RESULTS
  In the years 2000 and 2001, the adoption of guidelines reduced albumin consumption in hospitals 1 and 2. In hospital 1, where the release of albumin was carefully controlled by the transfusion service, albumin use per hospital stay decreased 8.7% in 2000 and 7.6% in 2001 from 1999; in hospital 2, use decreased 73.8% and 77.4%, respectively, from 1999. In hospital 3, rejection of the guidelines was coupled with an increase of 2.9% and 8.4%, respectively, in the amount of albumin used per hospital stay. In the years 2000 and 2001, the savings in the expenditure for albumin was ∼17,000 euro in hospital 1 and ∼200,000 euro in hospital 2.
  
  
  CONCLUSIONS
  This study confirms that the adoption of guidelines may substantially reduce the inappropriate use of albumin and relative costs.
authors.affiliation: Department of Internal Medicine, Division of Clinical Pharmacology and Toxicology, University of Genoa, Genoa, Italy.
authors.forename: Antonietta
authors.initials: A
authors.lastname: Martelli
authors.affiliation: Transfusion Service of Galliera Hospital, Genoa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Strada
authors.affiliation: Santa Corona Hospital, Pietra Ligure, Italy.
authors.forename: Ildefonso
authors.initials: I
authors.lastname: Cagliani
authors.affiliation: Department of Internal Medicine, Division of Clinical Pharmacology and Toxicology, University of Genoa, Genoa, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Brambilla
keywords: clinical use of albumin; efficacy of guideline application; guidelines