Stewardship of Intravenous Fluids During Shortage and Beyond.

Area of Science:

• Emergency Medicine
• Environmental Science
• Healthcare Management

Background:

• Supply chain disruptions underscore the need for improved intravenous (IV) fluid stewardship.
• Optimizing IV fluid use is crucial for efficient healthcare delivery and resource management.

Purpose of the Study:

• To quantify the number of IV fluid bags saved by implementing "round down" strategies in emergency departments.
• To estimate the environmental impact, including CO2 emissions and plastic waste, associated with reduced IV fluid bag usage.

Main Methods:

• Retrospective analysis of 30 mL/kg IV fluid bolus orders in adult patients from 2020-2023.
• Calculated potential IV fluid bag savings by rounding down to nearest 250 mL or 500 mL.
• Assessed projected environmental impact using established CO2 and plastic waste estimates.

Main Results:

• Rounding down could save up to 1567 IV fluid bags across 11,964 orders.
• Reduced IV fluid bag size for up to 3890 boluses, with median volume reduction of 121-244 mL per patient.
• Estimated reduction of 112.8 kg CO2 emissions and 14 kg plastic waste per 1000 patients.

Conclusions:

• A "round down" strategy for IV fluid resuscitation can substantially decrease IV fluid bag consumption.
• This approach offers significant environmental benefits through reduced CO2 emissions and plastic waste.
• Optimized IV fluid management enhances resource stewardship in emergency settings.