America's 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's promises to speed supplies into the country have repeatedly focused on ensuring that holiday gifts fill U.S. store shelves. "Only Santa Claus" can make sure they arrive on time, Biden said in a Dec. 1 speech about his administration's efforts. Medical supplies received a passing reference.
In the meantime, clinicians describe making do, which sometimes requires piecing together what's 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't be transported through normal hospital tube systems, so workers must walk samples to the lab instead of tending to patients.
Dr. George Morris, CentraCare's physician incident commander for covid response, worries about higher risk of harm for patients: "Now our supply shortage is actually affecting our ability to do the care."
"When you throw in all these variations — four different types of collection kits, an infinite number of different types of crutches — there's always that little slight chance of error," Morris said. "And that's unfortunate, but that's the reality."
"We just can’t get enough volume," said Kelsey Ochsner, CentraCare's manager of procurement. Federal emergency medical teams were dispatched to Minnesota in late November to help hospitals — including CentraCare's St. Cloud Hospital, the system's largest — 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.
"If you don't have health care workers, you can't do the work," said Debbie White, a registered nurse and president of Health Professionals and Allied Employees, a union in New Jersey. "Whatever supplies you have are kind of a moot point if you can't even take care of your patients."
A global aluminum shortage has left hospitals short on crutches, so clinicians have organized donation drives for gently used items. "Imagine trying to get around after hip surgery or after breaking your leg without the aid of these devices," read one recent call 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's 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.
"In some cases, you're paying more for freight than the product," 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.
"Anything plastic-wise has been a little bit slowed down," 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's inventory were delayed, compared with 1% or less during normal operations.
The hospital has urged clinicians to conserve supplies like tape and gauze. "We're asking them to really think before you use," Welch said. "If 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."
"This degree of disruption for this period of time is unusual," said Melanie Fisher, a senior vice president for Beaumont Health, which operates hospitals in Michigan.
"To have 100 back orders a day is much different than traditionally having 25," she said. "And to have back orders with either no substitutes available or having to make the kits ourselves when we're already short-staffed — these are the complexities of what we're working through now."
Still, "this is very different from the shortages we saw last year" 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: "People were actually infected, in certain cases actually died."
Hospital executives were split on whether actions taken by the Biden administration — forcing major ports to operate round-the-clock, lowering container fees and allowing truck drivers to work longer hours — were improving the situations in their facilities. Some, like Welch of Novant Health, haven't seen meaningful differences. Still, Fisher of Beaumont Health said, it's hard to imagine what would have happened without them.
Hospital workers hope for some improvement after the holiday season. Industry reports, however, are "predicting another 18 to 24 months of supply chain challenges," said Alyssa Kangas, CentraCare's 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 — and risk escalating prices.
"At that point, we're kind of at the mercy of the market," said Slade of Intermountain Healthcare, adding that he's concerned about price gouging when contracts come up for renewal. Oxygen tanks, he said, cost 600% more than they did a year ago. "I do see an avalanche of price increases in the future."
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.