The contrast dye shortage, caused by COVID-19 lockdowns in China, has spurred leaders at healthcare systems across the nation to come up with innovative solutions to continue services with rationed supplies.
This compilation features guidance from six leaders at five systems who shared insights with Becker's via email.
Question: What solutions are leaders implementing to work around complications presented by the contrast dye shortage?
Editor's note: Responses were lightly edited for clarity and length.
Kimberly Kallianos, MD. Director of Computed Tomography at UC San Francisco. UCSF has activated conservation strategies that include using noncontrast CT and, when possible, other imaging modalities such as ultrasound, nuclear medicine and MRI. Some outpatient exams for May and June have been rescheduled to a later date.
Since March 30, UCSF has reduced contrast use by 44%, ensuring that the health system has adequate stores for inpatients, emergency department exams, and outpatients who require critical short-term management. In partnership with the Pharmacy, we are monitoring weekly contrast delivery and utilization, repackaging smaller doses from 100ml and 500ml vials to be prepared when needed, as a conservation and waste reduction strategy.
We have notified referring providers across our system about the shortage and radiologists are available to advise on alternate exams for complex cases. Clinical information technology teams have developed a new triaging tool in our electronic health record that is applied when providers order contrast-enhanced CT examinations. Patient communication is ongoing, via outbound calls from central scheduling, notifications in a patient’s electronic health record, and digital signage at our imaging centers.
Bradley Delman, MD. Site chair for radiology at Mount Sinai Hospital (New York). Mount Sinai Health System is fortunate to have [a] hybrid supply of iodinated contrast. In radiology we use primarily Isovue for intravascular injections, and Bracco’s supply has been largely uninterrupted. But other services in our health system that rely primarily on Omnipaque for intravascular injection would be left with Isovue as their best option, as Omnipaque reserves are depleted.
When we learned about the shortage we reached out to pharmacy leadership to understand historical use patterns and identify at which sites and indications we could reduce contrast usage.
We also sent a systemwide broadcast notification to all credentialed providers to ensure they are aware of the shortage and apprise of optimal use cases and alternatives.
In our health system we rely on various concentrations and sizes of Omnipaque. For example, for GI opacification on CT imaging the 30 mL Omnipaque flip-top vial is very useful since it can be dispensed and diluted directly on a patient unit or in the emergency department. Other sizes or agents wouldn’t be nearly as convenient, so depletion of Omnipaque will require radiology to provide dilutions of another agent centrally. This is a process we haven’t done in years, and it’s very inefficient.
Intravenous contrast for CT scans is prescribed by radiology physicians so it is easier to control. Oral contrast is ordered by the requesting provider, so it has already been given by the time we can intervene. To address concerns about utilization we have sent daily emails to service leaders where use seems to exceed what is necessary to provide targeted education. We also worked with our EMR coding team to rework our orders to provide pointed decision-support to ensure we are conserving what we can. It was important to rein in those historical habits which can really deplete our supply faster than necessary.
Steve Downey. Chief supply chain & patient support services officer at Cleveland Clinic. The industrywide shortage of CT contrast has affected healthcare systems across the country, and we are in communication with the manufacturer daily. We are monitoring our existing inventory levels across all of our locations and implementing conservation strategies, such as repackaging contrast in smaller quantities to reduce waste. These measures have ensured we have what we need to care for our patients.
Paul Biddinger, Medical director of emergency preparedness at Mass General Brigham (Boston). We have actually had to take many different actions to respond to the shortage. The most significant have been:
- Convening leaders from across the system from all affected departments (radiology, cardiology, neurology, oncology, pain services, GI, anesthesia and others) to develop messaging to all affected users, to develop triage criteria for use of contrast if supplies are inadequate, to identify conservation strategies to help us use less contrast when possible, to identify alternative treatment and diagnostic plans if possible to spare use of contrast and to monitor utilization on a week-to-week basis
- Centralizing our ordering and allocation of contrast from more than 35 different units across the system to a single point of ordering and distribution. This has been incredibly labor intensive and is taking a large team many hours every week just to order and distribute the contrast.
- Repeating messaging to our clinical communities to keep them informed
- Rolling out best practice advisories built into the electronic health record to encourage conservation and adherence to identified best practices from the clinical groups
- Working with our existing manufacturer and distributor connections to maximize supply as well as to identify new vendors and potential new supplies of contrast
- Using just-in-time development of inventory and utilization dashboards to monitor our progress and our supplies.
- Communicating with our local, state and national hospital and healthcare association contacts regarding advocacy with payers to allow substitution of imaging modalities (i.e. MRI instead of CT) without the need for preauthorization or other hurdles during the peak of the shortage
- Collaborating with other hospitals in our region via our state hospital association to identify and share common best practices and ways to support each other
Malinda Gamble. Corporate director of imaging, and Heather Kountouris, Manager of pharmacy at Parkview Health (Fort Wayne, Ind.): Parkview Health has implemented a number of solutions to mitigate the impact of the contrast shortage. The pharmacy team is drawing up contrast into appropriately dosed syringes under USP 797 regulations, which has reduced waste and centralized the storage of contrast for better inventory control. Additionally, all departments that utilize contrast in procedures — such as radiology, cardiology, GI, pain management, etc. — have worked closely with the medical directors to adjust contrast protocols, leading to decreased contrast use and reduced waste.
These mitigation strategies, paired with collaboration between radiology leadership and pharmacy, have allowed Parkview to decrease contrast use by 20 percent, all while continuing to provide high quality imaging. Health system leaders continue to monitor the situation and are prepared to implement additional strategies as needed.