SHM Converge Scientific Abstract ePoster Gallery-Albumin Accountability: Guideline-Driven Use With a Pharmacist Safety Net

Pdf Summary

Northwell Health describes itself as New York State’s largest health care provider and private employer, focused on improving community health through high-quality care, education, research, and equitable access regardless of ability to pay.  

The document summarizes a quality-improvement project titled <strong>“Albumin Accountability: Guideline Driven Use with a Pharmacist Safety Net.”</strong> Albumin is widely used for certain evidence-based indications, such as large-volume paracentesis in cirrhosis, spontaneous bacterial peritonitis, hepatorenal syndrome, and therapeutic plasma exchange. However, local review found that albumin was often being ordered for lower-value uses such as hypotension, IV diuresis, and hypoalbuminemia due to malnutrition, leading to variation in practice, unnecessary cost, and potential overuse.

To address this, a multidisciplinary team created institutional guidelines to standardize albumin prescribing across the ED, inpatient medicine, surgery, and ICU services. The policy, launched in April 2025, included hospital-wide education and a pharmacy workflow in which all albumin orders were reviewed for appropriate indication. Non-guideline orders were clarified with prescribers and escalated to leadership when needed.

Results showed a substantial improvement: albumin use dropped by <strong>64% immediately after implementation</strong> and remained <strong>61% lower</strong> in the following quarter. Costs fell by <strong>65%</strong> during the implementation quarter and stayed <strong>58% lower</strong> afterward. Importantly, there were <strong>no observed negative effects</strong> on length of stay, mortality, morbidity, or readmissions.

The project concludes that guideline-based prescribing plus pharmacist oversight can reduce high-cost, low-value medication use safely, and the team plans to expand the approach across the health system and apply it to other overused therapies.

Asset Subtitle

Rishi Malhan

Meta Tag

Author List Bryant Faria, John Raimo, Joseph Eskandrous, Kasia HILLS Gejdel, Rishi Malhan

Category Innovations

Concept Intravenous Albumin

Concept Clinical Indication

Concept Low-Value Care

Concept Practice Guideline

Concept Evidence-Based Medicine

Distinguished Non-Finalist

Presenter Organization Northwell Health

Presenting Author Rishi Malhan

Track Quality Improvement

Keywords

Northwell Health

albumin

quality improvement

guideline-driven prescribing

pharmacist oversight

medication stewardship

cost reduction

evidence-based indications

hospital policy

overuse reduction

Intravenous Albumin

Clinical Indication

Low-Value Care

Practice Guideline

Evidence-Based Medicine