Resource management and clinical outcomes during a national intravenous fluid shortage.

Abstract

A natural disaster, Hurricane Helene, damaged a production facility supplying 60% of intravenous (IV) fluids in the United States. A nationwide IV fluid shortage followed. To evaluate a multifaceted IV fluid conservation intervention's effect on IV fluid utilization and clinical outcomes during the shortage. Retrospective, quasi-experimental study using interrupted time series and multivariable regerssion at the University of Utah Hospital, an 817-bed academic medical center. Inpatient admissions to surgical, medical, or obstetrics and gynecology services between July 1, 2024 and January 1, 2025 were included. The intervention comprised system-wide communications, health record modifications, leadership meetings, and real-time monitoring. The primary outcome was IV fluid utilization; secondary outcomes were length of stay, diuretic administration, acute kidney injury, renal replacement therapy, ICU transfer, hypotension, and inpatient and 30-day mortality. A total of 15,847 admissions were analyzed, including 8164 preintervention and 7683 postintervention admissions. Mean age was 52.9 years; 8621 (54.4%) were female. IV fluid utilization decreased from a mean (95% confidence interval [CI]) of 5.5 (5.3-5.7) bags to 3.5 (3.4-3.6) bags per admission following the intervention (p < .001). Length of stay decreased by 0.6 days postintervention (p < .001). Loop diuretic administration decreased (odds ratio [OR] = 0.87 [0.79-0.95]; p = .001), and an increase in acute kidney injury was observed (OR = 1.1 [1.0-1.3]; p = .024). No significant differences were observed for renal replacement therapy, ICU transfer, hypotension, or mortality outcomes. Reductions in IV fluid utilization, diuretic administration, and length of stay were observed following an IV fluid conservation intervention. Our strategies offer a framework for health systems facing similar shortages with the potential to improve clinical outcomes.