# Impact of Emergency Department Intravenous-Fluid Conservation Strategies During a National Shortage: Multisite Retrospective Study

## TL;DR

During a national IV fluid shortage, emergency departments reduced fluid use, saving costs and cutting emissions through conservation strategies.

## Contribution

Demonstrated that ED conservation strategies during a critical IV fluid shortage significantly reduced usage, costs, and environmental impact.

## Key findings

- IV fluid-bolus orders dropped by 22.9% during the shortage period.
- Cost savings totaled $27,202, with potential annual savings of $108,808.
- Carbon dioxide emissions decreased by 3.1 metric tons during the shortage.

## Abstract

Effective disaster response in healthcare depends on coordinated strategies that maintain access to critical supplies across institutions. During Hurricane Helene in September 2024, a major intravenous (IV) fluid shortage caused by the destruction of a manufacturing plant exposed the vulnerability of centralized supply chains. Our objective in this study was to evaluate the impact of a multisite IV fluid conservation initiative on ordering patterns, cost, and environmental outcomes across three emergency departments (ED).

We conducted a retrospective study evaluating large-volume, IV fluid-bolus orders placed before, during, and after the critical shortage. Interventions included an interruptive alert in the electronic health record, clinician education, and workflow adjustments. Our primary outcome measure was the number of IV fluid-bolus orders placed during each period. Secondary outcomes included total fluid volume administered, total cost of fluids, estimated carbon dioxide emissions, and the proportion of ED encounters involving fluid administration.

During the pre-shortage period, 24,251 IV fluid-bolus orders were placed across 41,752 ED encounters (41.8%). Orders dropped to 18,692 during the critical shortage across 39,840 encounters (30.8%), reflecting a 22.9% relative reduction. In the post-shortage period, 23,911 orders were placed across 40,967 encounters (39.6%), remaining slightly below baseline. Estimated cost savings during the shortage period totaled $27,202, with a projected annual savings of $108,808. Carbon dioxide emissions dropped by 3.1 metric tons—the equivalent of avoiding the use of over 349 gallons of gasoline.

Emergency department-based conservation strategies were associated with measurable reductions in IV fluid use, cost, and environmental impact. Further validation is needed to understand their impact on clinical outcomes and healthcare system resilience.