Metrics-driven successful strategy by emergency and radiology driven task force to mitigate global CT contrast media shortage in a safety net hospital

Abstract

Iodinated contrast media (ICM) shortages and secondary supply chain problems due to Coronavirus Disease lockdowns in China significantly impacted radiology operations nationwide. The lack of ICM necessitated operational workflow changes designed to ration contrast use, particularly in the hospital setting. In this manuscript, we share our strategic methods with advanced process/outcome metrics to monitor the effectiveness of our strategy under a coordinated multidisciplinary team effort. Alternate studies such as substituting magnetic resonance angiography for computed tomographic angiography for emergency department patients were studied to measure the suitability of these examinations for specific diagnoses. This article presents readers with a comprehensive crisis management strategy deployed at our institution, emphasizing various options with a limited ICM supply, and minimizing the impact on clinical care.

Shortage of iodinated contrast media: Status and possible chances – A systematic review

“…1 ). The remaining 22 papers [ [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ] served as basis for the following analysis, and contain a variety of different study types such as retrospective studies (n = 4), clinical perspectives (n = 3), special reports (n = 2), review articles (n = 5; including two narrative reviews), and others (n = 8). All articles are either published in the USA (n = 17) or in Australia (n = 5).…”

“…The Royal Australian and New Zealand College of Radiologists as well as authors from Yale have published further guidance on how to preserve ICM [ 4 ]. Following the persisting shortage, more publications discussing this issue have been released [ [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ].…”

“…In May 2022, the American College of Radiology (ACR) issued a statement with guidance on how to address the shortage [ 12 ]. In eight articles this guidance was considered [ [5] , [7] , [9] , [16] , [18] , [20] , [21] , [25] ], while two articles considered ICM conservation techniques of Yale School of Medicine [ [4] , [5] ]. We can discriminate two main strategies: 1) Reduction of the number of contrast-enhanced image-guided examinations and/or 2) reduction of the (single) ICM dose ( Figure 2 ).…”

“…Optimizing the amount of waste is another approach. This means we can reduce waste either by using smaller vials per examination or by splitting single vials into multiple doses if the necessary precautions can be taken [ [4] , [6] , [7] , [8] , [10] , [11] , [15] , [18] , [20] , [22] , [23] , [25] ].…”

“…We distinguish between reduced dose per examination, reduced number of examinations and the total reduction from these two parameters. First author (year) [ref] Reduced CM dose Reduced examination frequency Total ICM reduction Forouzandeh F et al 2022 [ 15 ] 46% Allen L et al 2022 [ 8 ] 50% Salazar G et al 2022 [ 20 ] 50% Barreto I et al 2022 [ 10 ] 66% 34% Amukotuwa SA et al 2022 [ 5 ] 93% 85% Amukotuwa SA et al 2022 [ 7 ] 16% 59% 65% Amukotuwa SA et al 2022 [ 13 ] 16% 61% 67% Bammer R et al 2022 [ 21 ] 88% 75% 72% Davenport MS et al 2022 [ 14 ] 25% 78% 83% Gopireddy DR et al 2023 [ 25 ] 80% Rosander A et al 2023 [ 23 ] 43% 50% Glazer D et al 2023 [ 16 ] 12% …”