Cleveland-based University Hospitals typically consume 2,600 liters of intravenous fluids per day. However, with the temporary closure of the nation's primary manufacturer of IV fluids, the system is now tasked with reducing its daily average to about 1,100 liters — a 40% cutback.
In late September, Hurricane Helene caused flooding at Baxter International's North Cove facility in Marion, N.C., which produced 60% of the U.S. IV fluid market's supply.
As the country imports IV products and Baxter works to restart the plant's manufacturing lines, at least 22 health systems have delayed surgeries to conserve IV fluids.
However, University Hospitals — which operates 21 hospitals, about 50 health centers and outpatient facilities and more than 200 physician offices — has not had to delay surgeries, according to Peter Pronovost, MD, PhD, chief quality and clinical transformation officer.
He told Becker's that University Hospitals has achieved this success by encouraging employees to innovate with their own mitigation strategies.
The system sent a simple memo to staff that Dr. Pronovost said is rarely used in healthcare: "We need your help."
"You would have thought that saying, 'We have to cut 40% of fluid [use] or we're going to have to close surgeries' would have instilled fear.". But the response from employees, he said, "was palpable. They came up with brilliant ideas and we ended up reducing our fluid use by 65%."
"The wisdom is with the people closest to the work," he added.
One tactic the system employed was eliminating "keep vein open" orders for IV fluids. Another strategy, which resulted in most of the savings, involved switching procedures requiring less than one liter of fluid to oral hydration before the procedure, a hep-lock (heparin IV locking device), and oral hydration afterward.
Another mitigation idea involved patients who were discharged with orders for IV hydration. University Hospitals found that between 40 to 50 patients each day could be discharged with oral hydration orders instead.
The system is now asking frontline workers which strategies worked, which did not and which should continue after the shortage eases, Dr. Pronovost said: "We will never go back to wasting it like we did."