The impact of the 2024 intravenous fluid shortage on emergency department length of stay and 72-hour return rate

Abstract

Introduction

In September 2024, there was an abrupt intravenous (IV) fluid shortage in the United States due to the unexpected closure of a major production facility. In response, hospitals rationed scarce IV fluids. While this was aimed at reducing utilization, the impact on patient care is unclear. This study assesses the impact of reduced IV fluid ordering on emergency department (ED) operational metrics.

Methods

Retrospective cohort study at an urban academic medical center ED with 55,000 annual encounters. All patients seen during the pre-shortage (7/1/24–9/30/24) and post-shortage (10/1/24–11/13/24) periods were included. We assessed differences between proportions of patients receiving IV fluid, volume of fluids, length of stay (LOS), and 72-h return rate. We also assessed a subgroup of discharged patients with gastrointestinal illness. Comparisons used a Wilcoxon ranked-sum, Chi-squared or Fisher's exact test as appropriate. Logistic regression was performed with controls for age, gender, and emergency severity index (ESI).

Results

IV fluids were given in a smaller proportion of patients (20 % vs 24 %, p < 0.001) and at lower volumes post-shortage. Discharged patients with gastrointestinal symptoms likewise had lower IV fluid use (30 % vs 42 %, p < 0.001), decreased LOS (7.1 vs 7.8 h, p < 0.001) and no change in 72-h return rate (p = 0.156).

Discussion

During the 2024 IV fluid shortage, fewer patients received fluids at lower volumes per patient. This held true for discharged patients with GI symptoms. Overall, LOS decreased without an increase in 72-h return rate. Improved throughput without changes in return rate represents a potential process improvement and warrants further evaluation.