10/24/2024

Criteria for Postponing Non-Emergent & Non-Urgent Procedures due to National IV Fluid Shortage

Ohio hospitals and practices have been implementing a variety of conservation methods to preserve inventory, as it's clear normal levels won’t return for several months. A statewide group of perioperative experts has convened to develop principles for prioritizing which procedures should or should not be postponed if the conservation methods do not preserve enough supply.

OSMA and the Ohio Hospital Association are distributing the below document based on these recommendations should your healthcare institution need to safely postpone some procedures using “Allocation of Scarce Medical Resources” principles.

Updated October 16, 2024

As Ohio hospitals respond to the shortage in IV, OR irrigation and dialysate fluids due to the impact of Hurricane Helene, health care organizations across the nation are engaging in a variety of conservation methods to preserve the inventory of these products.  Regardless of which IV fluid vendor they use, all hospitals in Ohio are implementing some conservation efforts. 

A statewide group of perioperative experts was convened to develop principles for prioritizing which procedures should or should not be postponed if the initial rounds of conservation do not preserve enough supply or if the shortages continue for a longer period of time than expected. 

This document outlines a framework that hospitals and health systems can use to implement more aggressive conservation measures by safely postponing some elective procedures using “Allocation of Scarce Medical Resources” principles.

High Priority Criteria:

A surgery/procedure should not be postponed if doing so could reasonably be expected to cause a:

1. Threat to the patient’s life;
2. Threat of permanent dysfunction of an extremity or organ system;
3. Risk of cancer metastasis or progression of cancer staging;
4. Risk of the patient’s condition rapidly worsening or progressing to severe symptoms (e.g., severe pain, bowel obstruction, GI bleed, etc.)
5. Significant delay in diagnosis based on an abnormal imaging or physical finding (e.g., a biopsy of a palpated mass or mass seen on imaging)
6. Significant delay in performing a high priority procedure or treatment (e.g., a line placement required to proceed with chemotherapy, a hemodialysis catheter placement in preparation for hemodialysis, etc.)
7. Significant delay in care/risk of delay in care or significant patient flow failure (staged treatment, prior delayed care, ICU patient transitioning to less acute bed care as a consequence of surgery).

If a patient meets any of criteria 1-7 above, the surgery/procedure should be highly prioritized and should not be postponed unless other lower priority surgeries/procedures have already been postponed. 

If the hospital determines that some surgeries/procedures need to be postponed as a conservation strategy, surgeries/procedures that do not meet criteria 1-6 above should be prioritized based on:

• The risk to the patient’s long-term health/medical condition if the surgery/procedure is postponed;
• The impact of the condition for which the surgery/procedure is being performed on the severity of the patient’s symptoms (e.g., pain, weakness, etc.) or the impact on the patient’s functional status (e.g., ability to work, go to school, function as a parent or caregiver, etc.);
• The inventory on hand for the IV fluids required for the patient’s surgery/procedure and recovery; and
• The amount of IV fluids required to perform the surgery/procedure.