Baxter IV shortage: Inova’s immediate recommendations for urology practices

The Impact of Hurricane Helene Destruction of Baxter Factory: Immediate Recommendations for Urology Practices in United States to Preserve IV (Intravenous) and other Fluids

By Inger Rosner, MD and J. Stephen Jones, MD
Inova Health System, Fairfax VA

Hurricane Helene has caused widespread devastation, resulting in loss of life, homes, and businesses. A significant consequence of this disaster with immediate implications for urology is the flooding and indefinite shutdown of the Baxter International North Cove facility in Marion, NC, located 35 miles from Asheville.

The Baxter facility is one of the nation’s largest suppliers of IV fluids and fluids used for urological surgery as well as bladder irrigation. With the North Cove facility offline, hospitals using it as a supplier have been informed to expect only 40% of their usual IV fluid supply, raising significant concerns for patient care considering most U.S. hospitals have just enough supplies onsite to continue patient care for a few weeks at their baseline utilization run-rate.

Over the past decade, healthcare systems have increasingly faced medication shortages and supply chain disruptions. For that reason, Inova Health System has established incident management teams to implement emergency plans that allow us to adapt swiftly to these challenges. Inova, a nonprofit organization serving northern Virginia and Washington, DC, includes five hospitals and multiple surgery centers. Inova partners with the University of Virginia Medical School and offers extensive training programs for residents and fellows across various medical specialties.

Urology is one of the most significant consumers of IV and other fluids, particularly for irrigation and visualization during procedures, as well as for pre-, intra-, and post-operative management. Considering the current potential crisis, it is crucial to develop guidelines to decrease fluid utilization, and to prioritize surgeries that have a high demand for these fluids.

Considering the current crisis, our multidisciplinary team immediately sought to determine the impact and took action to preserve fluids to assure safe patient care regardless of the duration of this potential crisis. We identified a number of urology cases that typically involve very high fluid use (see box). As a result, we developed internal guidelines that we now offer to other urologists and hospitals as immediate steps to reduce the likelihood of running out of IVF for lifesaving care as follows:

Beyond urology, we also recommend reconsideration of liposuction procedures, which are completely elective and involve massive fluid use.

Our internal prediction model built in Epic’s Slicer-Dicer functionality originally projected we would be without critical IV fluids within 14 days without urgent action. But by making these rapid changes through an “all hands on deck” systemwide fluid stewardship effort, we have already reduced overall fluid utilization of our most common IV fluids such as normal saline and D5W by 50%  within one week (Figure 1). As a result, our projection is that we will be able to continue mostly normal operations even if our 40% allocation remains in place for months, and if the allocation increases even modestly as rumored to be near, we should be able to resume most of these surgical cases within a week or two.

It is now essential to educate our surgical and anesthesia teams about the ongoing shortages and the need for conservative fluid management practices. We must remain sensitive to the increased stress and burnout among healthcare professionals, as these challenges may amplify existing frustrations.

Healthcare crises impact not only patients but also the well-being of our teams. The emotional toll experienced during the COVID-19 pandemic serves as a reminder of the importance of patient safety and clear communication. When discussing treatment alternatives with patients, it is vital to explain the rationale behind changes and reassure them that other options are both safe and effective. As part of that, we have made direct contact with affected surgeons to assure they know these actions will be as brief as necessary, and only taken to preserve lifesaving fluids that could reach crisis.

As we navigate this current shortage, we must also emphasize alternative hydration methods and conservation strategies. Recommending patients drink clear liquids up to two hours before procedures is a simple step to lessen the need for bolusing operative patients upon admission. Converting medications to oral or IV push instead of drip is another significant opportunity for fluid stewardship. This situation will not be the last medical crisis we will encounter. Moving forward, preparedness, effective communication, collaboration, and adaptability will be essential for the safety and well-being of both patients and healthcare teams. These lessons from the pandemic prepared Inova for the current crisis and our learnings from this one must prepare us even more for the inevitable next one.