Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Background: Intravenous (IV) fluids are commonly used in emergency departments (ED), but their supply can be vulnerable to national shortages. In September 2024, Tropical Storm Helene disrupted production at a major manufacturing facility, triggering a nationwide IV fluid shortage. In response, our ED implemented a multiphase intervention aimed at reducing non-essential fluid utilization. We aimed to reduce total IV fluid use in the ED by at least 25% through a staged, systems-based conservation strategy.

Methods: We conducted a single-center, retrospective, pre-post quality improvement initiative in a tertiary academic ED with approximately 57,000 annual visits. Interventions were deployed across three Plan–Do–Study–Act cycles: 1) clinician education on fluid stewardship (7 days); 2) protocol modifications to reduce routine IV placement (11 days); and 3) electronic health record (EHR) clinical decision support tools, including an interruptive alert and oral hydration order set (32 days). We analyzed daily fluid administration volumes, and ED census data from September 2024 (pre-intervention) and November 2024 (post-intervention). The primary outcome was total IV fluid usage per day; a secondary outcome was IV fluid volume per patient encounter. We compared mean daily utilization between periods using two-sample t-tests.

Results: Average daily IV fluid use declined from 56.3 to 24.8 liters, a 56.0% relative reduction (P < .001), while ED volume remained stable (155.4 vs 153.1 encounters/day pre- vs post-intervention). Normalized per-encounter IV fluid administration decreased from 0.36 to 0.16 liters per visit (P < .001), representing a 56% relative reduction. Assuming a pharmacy acquisition cost of approximately $2 per liter of crystalloid, the intervention was associated with an estimated reduction of $63 in IV fluid expenditures per day (31.5 liters), or $1,890 over the 30-day post-intervention period.

Conclusion: A structured intervention combining education, protocol changes, and EHR decision support significantly reduced IV fluid use in the ED without disrupting operations. This approach may serve as a scalable model for resource stewardship during future supply chain crises. The most substantial reductions occurred during the final intervention phase involving EHR-based decision support.