Critical Patient Care Backorders: How can we do better?
You’ve heard “it’s not about PPE anymore” but are you aware of current critical shortages or discontinued supplies and equipment in the past weeks of 2021. Let’s begin with renal dialysis supplies and equipment. According to the National Institute of Diabetes and Digestive and Kidney Diseases* chronic kidney disease (CKD) affects more than 1 in 7 U.S. adults—an estimated 37 million Americans especially those with diabetes or high blood pressure for whom the risk for CKD is even greater. Compound that with the high demand of inpatient dialysis due to complications of Covid when it was known early as April of 2020 in the US and England that “more than a quarter of patients with covid-19 on ventilators also need renal support in the form of dialysis, raising concerns that there could be significant supply problems as countries attempt to stock up on the required fluid and plastic consumables.” # The proverbial red flag was raised world wide 20 months ago and counting. With the latest variants- Delta and Omicron, the US is now in higher demand of renal dialysis in all patient populations but low on dialysate fluids, dialyzers for equipment, and as well as trained nursing and technical staff shortages. This has gone as far as affecting outsourced 3rd party dialysis services which have cut back or stopped providing in some areas.
Next up is the global shortage of silicone rubber. You might first think this topic is going to discuss computer chips but hold that thought its about medical devices and supplies like urinary and intravenous catheters and tubes that are needed for patients sensitive to, allergic to or cannot tolerate latex or other materials for best care. Healthcare as strived for more than 30 years to become latex free or at minimum latex safe. Earlier in 2021 it was the shortage of raw materials to make non-latex nitrile gloves that brought back latex gloves to a small extent into the medical environment that worried some about reigniting the exposure cycle. Now “ it’s about changes in supply and demand, pandemic-related problems with shipping/logistics, manpower, and raw materials”+ that may be unwittingly bringing back latex containing products. Supply Chain and Value Analysis professionals report that they are being told to buy or being sent latex products as orders are fulfilled as all that is available.
Another hard hit area even before the pandemic but only exacerbated today are pediatric ICU supplies. A December 28,2021 ABC News report stated “Daily pediatric COVID-19 related hospital admissions have more than doubled in the last month, increasing by 110%. Now, an average of more than 300 children are being admitted to the hospital each day.” ! Hospital practitioners with pediatric populations have a limited array of manufacturers, types, sizes and general availability of supplies on a routine basis, especially in the winter months and with hospitalizations on the rise during this time products are either discontinued or hard to find after hours and hours of professional sleuthing.
In additional to supply and demand, raw materials or production lags a basic principle of doing business has been violated-COMMUNICATION. After a 40+ year healthcare career it still amazes me that a few minutes spent on well placed calls, emails, texts, website updates even social media posts delivered in a helpful manner hardly exists. When conversations do happen it’s more the norm that lists of like products or other manufacturers who might be able to assist are non-existent. Some healthcare systems report upwards of 15-20 different backordered products a day and may not be alerted to this condition until an order is placed which is especially alarming when time is of the essence. Think about that- one health system X over 5,400 US systems potentially looking for just one of the same backordered product each day, each on the same rate-limiting cycle.
I carefully curated this blog to illustrate that in many cases even as early as April 2020 many of these facts were known with realistic, fact based predictions of what was to come. How can we do better? Visibility in the end-to-end supply chain; why, what, how many available, how long should they last based on run rate, when will the next production start and be available. A prediction made in a DeLoitte paper about 2020 ^ concerned helping long supply chains- we need to shorten them, fill them with what’s needed and use automated, data driven tools to anticipate the next big need. We talk about having a fully transparent system with actionable timelines and a robust communication system to assure care is not disrupted now we really do have to deliver it.
The author has no conflict of interest to divulge.