America鈥檚 hospitals, strained by nearly two years of fighting the covid-19 pandemic, are now scrounging for basic medical supplies.
In another consequence of the global supply chain crisis, hospitals managing holiday covid surges and all their other patients are running short of many necessities of care: crutches, syringes, needles, tubing, gloves, catheters, drapes for surgery, suction canisters for medical waste and even urine cups.
After the difficulties that health care workers faced in securing personal protective equipment in 2020, supply chain managers and other experts say shortages and delays of other common supplies escalated this year.
President Joe Biden鈥檚 promises to speed supplies into the country have repeatedly focused on ensuring that holiday gifts fill U.S. store shelves. 鈥淥nly Santa Claus鈥 can make sure they arrive on time, Biden said in about his administration鈥檚 efforts. Medical supplies received a passing reference.
In the meantime, clinicians describe making do, which sometimes requires piecing together what鈥檚 needed with odds and ends. And while they play MacGyver, their attention can be diverted from patient care.
In late November, executives at CentraCare in Minnesota said a lack of the urine collection kits the health system uses forced them to secure four alternatives and even order individual parts to make their own. Some of the cups can鈥檛 be transported through normal hospital tube systems, so workers must walk samples to the lab instead of tending to patients.
Dr. George Morris, CentraCare鈥檚 physician incident commander for covid response, worries about higher risk of harm for patients: 鈥淣ow our supply shortage is actually affecting our ability to do the care.鈥
鈥淲hen you throw in all these variations 鈥 four different types of collection kits, an infinite number of different types of crutches 鈥 there鈥檚 always that little slight chance of error,鈥 Morris said. 鈥淎nd that鈥檚 unfortunate, but that鈥檚 the reality.鈥
鈥淲e just can鈥檛 get enough volume,鈥 said Kelsey Ochsner, CentraCare鈥檚 manager of procurement. Federal emergency medical teams were in late November to help hospitals 鈥 including CentraCare鈥檚 St. Cloud Hospital, the system鈥檚 largest 鈥 manage a spike in covid infections.
The scarcity of supplies is driven by raw material shortages, port backlogs, shipping delays and a dearth of truck drivers for transporting goods. Another factor making things worse for hospitals in general: staff shortages.
鈥淚f you don鈥檛 have health care workers, you can鈥檛 do the work,鈥 said Debbie White, a registered nurse and president of Health Professionals and Allied Employees, a union in New Jersey. 鈥淲hatever supplies you have are kind of a moot point if you can鈥檛 even take care of your patients.鈥
A global aluminum shortage has left hospitals short on crutches, so clinicians have organized donation drives for gently used items. 鈥淚magine trying to get around after hip surgery or after breaking your leg without the aid of these devices,鈥 read one for walkers, canes and crutches from Utah hospitals, including Intermountain Healthcare and University of Utah Health.
The campaign, called Lean on Utah, collected items on three Saturdays this fall, bringing in 963 sets of crutches, 652 walkers, 333 canes and 153 nonmotorized wheelchairs.
Gordon Slade, Intermountain鈥檚 senior director of supply chain logistics, said lead times are so long that the health system has paid for expedited shipping, pushing costs ever higher.
鈥淚n some cases, you鈥檙e paying more for freight than the product,鈥 he said.
Microchip and metals shortages have slowed the production of wheelchairs and other medical equipment. Also scarce are resin and silicone, used for canisters, catheters and the kits used to insert them in patients.
鈥淎nything plastic-wise has been a little bit slowed down,鈥 said Mark Welch, senior vice president of supply chain for North Carolina-based Novant Health. Among the items delayed are catheters, syringes, gauze and medical tape. As of early December, about 6.5% of items in Novant Health鈥檚 inventory were delayed, compared with 1% or less during normal operations.
The hospital has urged clinicians to conserve supplies like tape and gauze. 鈥淲e鈥檙e asking them to really think before you use,鈥 Welch said. 鈥淚f you happen to just grab extra things to take to the room because you think you might use it, a lot of times it gets wasted.鈥
鈥淭his degree of disruption for this period of time is unusual,鈥 said Melanie Fisher, a senior vice president for Beaumont Health, which operates hospitals in Michigan.
鈥淭o have 100 back orders a day is much different than traditionally having 25,鈥 she said. 鈥淎nd to have back orders with either no substitutes available or having to make the kits ourselves when we鈥檙e already short-staffed 鈥 these are the complexities of what we鈥檙e working through now.鈥
Still, 鈥渢his is very different from the shortages we saw last year鈥 related to PPE, said Tinglong Dai, a professor of operations management and business analytics at Johns Hopkins University. With those, Dai said, the danger was grave: 鈥淧eople were actually infected, in certain cases actually died.鈥
Hospital executives were split on whether actions taken by the Biden administration 鈥 forcing major ports to operate round-the-clock, lowering container fees and allowing truck drivers to work longer hours 鈥 were improving the situations in their facilities. Some, like Welch of Novant Health, haven鈥檛 seen meaningful differences. Still, Fisher of Beaumont Health said, it鈥檚 hard to imagine what would have happened without them.
Hospital workers hope for some improvement after the holiday season. Industry reports, however, are 鈥減redicting another 18 to 24 months of supply chain challenges,鈥 said Alyssa Kangas, CentraCare鈥檚 senior director of contracting and procurement.
Many hospitals contract with group-purchasing organizations to secure discounts from vendors. Managers said the contracts have offered protection against price gouging. But with the supply logjam, they might have to go off-contract to lock down goods 鈥 and risk escalating prices.
鈥淎t that point, we鈥檙e kind of at the mercy of the market,鈥 said Slade of Intermountain Healthcare, adding that he鈥檚 concerned about price gouging when contracts come up for renewal. Oxygen tanks, he said, cost 600% more than they did a year ago. 鈥淚 do see an avalanche of price increases in the future.鈥