Navigating the Global IV Contrast Shortage: The Experience of a Comprehensive Cancer Center

Abstract

In March 2022, a COVID-19 associated lockdown at an intravenous (IV) contrast production facility resulted in global shortages. We report our experience as a comprehensive cancer center navigating the IV contrast shortage through the development of an IV contrast triage team. A triage prioritization system was established to serve as a guideline for ordering clinicians to reduce contrast use (Table 1). The triage team reviewed all requests and made final determination based on patient history, treatment plan, prior imaging, possible alternative modalities, and competing requests. Our institution performed a median of 194 CT studies per day. Contrast utilization as a percentage of all CTs ordered was approximately 80% prior to the shortage, nadired at 9% during peak shortage, and has since returned to pre-shortage levels. While most requests for contrast were changed to non-contrast by the ordering clinician, 132 requests were reviewed by the triage team. Fifty studies (38%) were approved by the team for contrast administration, 56 (42%) were recommended to be performed without contrast, 15 (11%) for a change in modality, and 11 (8%) were felt suitable for delay. There was overall general concordance between the recommendations of the triage team and studies conducted without significant distributional differences (χ2 = 4.004, two-tailed p = 0.2610). We did not note any instances of patient harm associated with the lack of contrast or from the utilization of an alternative imaging modality. The concept of resilience involves the development of system-based practices that allow for sustained operations during periods of sudden change, or loss of critical supplies. The effort to optimally allocate limited supply of contrast was an extensive effort across the organization including from senior leadership, IT, radiology, nursing, physicians, and APPs. Defaulting to an automatic cancelation of contrast requests, followed by review from an interdisciplinary triage team was effective in safely reducing contrast utilization. Decisions made by the team appeared to be sound without any known patient harm.