Reduced IV fluid use and operational effects among emergency department patients during a national shortage.

BACKGROUND

Intravenous (IV) fluids are an essential therapeutic in emergency care, frequently administered for a wide range of acute conditions. In September 2024, Hurricane Helene forced the closure of a major U.S. IV fluid manufacturing facility, triggering a nationwide shortage. While many health systems rapidly implemented conservation strategies, the downstream operational and clinical effects of reduced IV fluid allocations on emergency department (ED) care remain unknown.

METHODS

We conducted a retrospective analysis of discharged ED encounters from nine hospitals within a regional health system, comparing pre- and post-shortage periods. The primary outcomes were the proportion of discharged patients receiving IV fluids and ED length of stay (LOS). Secondary outcomes included 72-h return ED visits, and the proportion of encounters receiving IV fluids among prespecified high-risk conditions (sepsis, diabetic ketoacidosis (DKA), and sickle cell vaso-occlusive crisis).

RESULTS

182,487 ED discharge encounters (96,045 pre and 86,442 post intervention) across nine sites were included. The proportion of discharged patients receiving IV fluids fell from 19.8% to 6.5% (absolute difference -13.2 percentage points, 95% CI -13.5 to -12.9). Odds of receiving IV fluids decreased across all top 20 diagnostic categories (OR range 0.10-0.39; e.g. diverticulitis OR 0.10 95% CI [0.06, -0.15], headache 0.13, [0.11,0.15]). The IV fluid shortage was associated with an increased ED LOS for many high-volume conditions (range 6 to 31 min) while only respiratory symptoms had a significantly decreased LOS (-14 min, 95% CI -19, -8). Significant increases in 72-h return visits occurred for diabetes complications, alcohol-related disorders, and upper respiratory infections. Among high-risk conditions, the proportion of all ED encounters receiving IV fluids was similar in diabetic ketoacidosis but declined in sepsis and sickle cell vaso-occlusive crisis.

CONCLUSION

The 2024 IV fluid shortage was associated with substantial changes in ED treatment patterns for discharged patients, with reduced fluid use and variable impacts on LOS across conditions. While care for some high-risk diagnoses remained stable, others, such as sickle cell vaso-occlusive crisis, experienced notable declines, underscoring the need for more nuanced and diagnosis-specific resource allocation strategies during future supply shocks.