Supply Chain Stewardship

Healthcare supply chain disruptions have emerged as a major challenge nationwide, fundamentally reshaping clinical practice and patient-care delivery within hospitals. As clinicians, we increasingly find ourselves in situations where essential resources—from critical medications to diagnostic supplies—are limited or unavailable. These scenarios demand complex clinical judgments and creative workflow adaptations. Recent data underscores how prevalent this challenge has become: approximately 40% of healthcare practitioners reported regular cancellations or delays in patient care due to shortages in 2023, a marked increase from prior years.¹ Additionally, a survey by the American Hospital Association revealed nearly 80% of hospitals experienced substantial medication shortages in 2021, highlighting the urgency for proactive, innovative strategies.²

Complicating this landscape, new tariffs on imported medical products, notably pharmaceuticals and diagnostic materials, have heightened concerns about future shortages. Economic projections suggest these tariffs could increase the cost of essential medical supplies by up to 15%.³ Such significant cost hikes directly impact healthcare budgets and intensify resource scarcity as facilities strive to secure affordable alternatives, thus further pressuring already strained hospital operations.

In recent years, we have navigated numerous critical supply shortages, including blood culture bottles, iodinated contrast media, intravenous fluids, and nuclear medicine isotopes. Each crisis required distinct and agile responses.

The blood culture bottle shortage of 2024, driven by manufacturing disruptions, necessitated an urgent shift toward diagnostic stewardship. Across hospitals nationwide, we implemented rigorous stewardship protocols and introduced electronic prompts within electronic health record (EHR) systems, significantly reducing unnecessary culture orders. Virginia Commonwealth University Health notably achieved a reduction in blood culture orders exceeding 35%, exemplifying effective stewardship without compromising patient safety.⁴

Similarly, the iodinated contrast media shortage in 2022, precipitated by the temporary closure of a major production facility in Shanghai, required quick collaborative action. Institutions like UCSF Health revised CT imaging protocols, employing weight-based contrast dosing and selectively omitting contrast in low-risk clinical scenarios, thus conserving up to 83% of dye usage while preserving diagnostic accuracy.⁵

The shortage of radioisotopes used in nuclear medicine further illustrated the vulnerability of the global supply chain. The 2024 disruption in molybdenum-99 production, critical for generating technetium-99m, used widely in cardiac imaging, forced rapid clinical adjustments. Hospital-based clinicians, in partnership with cardiologists and radiologists, swiftly transitioned patients to alternative modalities such as PET scans and stress echocardiography. This rapid adaptability prevented significant diagnostic delays, underscoring the importance of interdisciplinary flexibility during resource constraints.

Natural disasters have repeatedly exposed supply chain weaknesses, further demanding resilient systemic solutions. Hurricane Helene’s severe impact on Baxter’s IV fluid plant in 2024 resulted in widespread saline shortages. Hospitals responded with immediate, aggressive conservation measures, shifting toward oral hydration, refining IV medication protocols, and leveraging emergency imports temporarily authorized by the U.S. Food and Drug Administration.⁶

Throughout these crises, clinicians have not only adapted at the bedside but have actively spearheaded institutional innovation. By developing and deploying new workflows embedded with principles of resource stewardship, clinicians have transformed routine clinical practices. These workflows, initially established as crisis responses, now promise long-term value, potentially becoming permanent fixtures in healthcare delivery. Practices such as transitioning appropriate medications from intravenous to oral administration and integrating EHR decision-support tools exemplify this transformation. Through transparent communication, ethical frameworks, and proactive adaptation, hospitalists uphold patient trust and safety during these challenging shortages.

Beyond operational changes, these disruptions have triggered a significant cultural shift within healthcare institutions—from a mindset prioritizing exhaustive diagnostic testing toward one emphasizing clinical appropriateness and resource conservation. This cultural evolution, championed by clinicians, encourages interdisciplinary collaboration among nurses, pharmacists, and laboratory personnel. Such shifts not only optimize resource management but also significantly enhance patient care by minimizing unnecessary interventions, reducing healthcare-associated risks, and improving overall patient safety.

Furthermore, embedding principles of resource stewardship into medical education and training ensures that future healthcare providers adopt this conservation-oriented mindset early in their careers. Simulation-based training exercises, interdisciplinary case discussions, and integrated clinical decision support tools are helping institutionalize this culture change. Recognition programs that celebrate teams successfully implementing resource-efficient care further reinforce positive behavior and motivate sustained engagement among healthcare providers.⁷

Additionally, adopting a conservation-oriented approach has substantial environmental implications. Excessive use of medical resources, particularly single-use plastics and chemical-based products, contributes notably to environmental pollution and climate change. By embedding resource stewardship and sustainability into daily clinical practice, healthcare providers not only improve operational efficiency but also contribute positively to environmental goals, aligning healthcare delivery with broader sustainability initiatives.

Hospitalists can play a pivotal role in sustainability efforts by initiating practices such as reducing unnecessary diagnostic testing, advocating for eco-friendly clinical supplies, and educating clinical teams about environmentally conscious healthcare practices. Their frontline perspective uniquely positions them to identify and address wasteful practices, lead hospital-wide sustainability committees, and implement recycling programs in clinical areas.⁸

The use of digital innovation has been pivotal in supporting these systemic changes. Predictive analytics and AI-powered inventory-management systems enable facilities to anticipate shortages proactively, permitting timely, preventive actions. EHR-based decision support tools, such as Best Practice Advisories, effectively guide clinical behaviors towards conservation and clinical appropriateness, providing clinicians with real-time, actionable guidance. Emerging technologies, including blockchain, promise further long-term solutions by enhancing supply chain transparency and traceability.⁹ Additionally, advancements in 3D printing offer hospitals the capability to produce certain medical supplies rapidly on-site during shortages. Items such as surgical instruments, personal protective equipment components, and specialized medication-delivery devices can be custom-printed quickly, alleviating immediate supply constraints and enhancing self-sufficiency during crises.¹⁰

Innovations in care delivery, notably telemedicine and remote patient monitoring, have also gained prominence. Integrating these technologies has allowed effective patient care management remotely, thereby alleviating pressure on inpatient resources. Automation technologies, such as robotic medication dispensing systems and smart IV pumps, further enhance resource optimization, reduce errors, and allow clinicians more direct patient interaction, enhancing overall care quality.

From our vantage point as frontline clinicians, advocacy for systemic changes remains essential. Our experiences uniquely position us to influence policy discussions regarding tariffs, international supply chain management, and resource stewardship programs. By advocating for diversified sourcing strategies, strategic national stockpiles, and regulatory flexibility during crises, we can actively prevent or mitigate future disruptions.

As we look ahead, our continued engagement in refining clinical protocols, embedding sustainable practices, and adopting innovative digital solutions remains paramount. The ongoing supply-chain challenges present unique opportunities to reinforce collaborative approaches, integrate proactive planning, and further establish hospitalists as central leaders in driving resilience within healthcare systems.

The valuable lessons learned from recent supply-chain disruptions have equipped us with robust tools and strategies that will permanently enhance our approach to resource management. Many of the workflows and clinical adjustments adopted during these crises will endure, continuing to minimize resource waste and foster efficiency even beyond periods of scarcity. These experiences underscore the critical importance of adaptability, proactive preparedness, and interdisciplinary collaboration—essential qualities that define our evolving role in healthcare.

Ultimately, by embracing these lessons and leading the charge toward more sustainable, resilient, and patient-centered care, we ensure the ongoing delivery of high-quality healthcare. Our collective efforts not only address immediate clinical challenges but also significantly contribute to building stronger healthcare systems capable of weathering future uncertainties. 

Dr. Patel is the chair of the inpatient clinical informatics council, the medical director of virtual medicine, and a hospitalist at Ballad Health System in Johnson City, Tenn. He is also chair of SHM’s Health Information Technology Special Interest Group.

References

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6. Centers for Disease Control and Prevention. Disruptions in availability of peritoneal dialysis and intravenous solutions from Baxter International facility in North Carolina. CDC Health Alert Network. Available at: https://www.cdc.gov/healthcare-associated-infections/bulletins/shortage-of-iv-and-peritoneal-dialysis-solutions.html. Published October 28, 2024. Last updated October 30, 2024. Accessed March 27, 2025.
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