The Nuance of Clinical Decision Support in Intravenous Fluid Shortages

After Hurricane Helene made landfall in September 2024, the U.S. faced a nationwide intravenous (IV) fluid shortage due to damage at a key manufacturing facility. To prioritize supplies for the most critical patients, Yale - New Haven Health System (YNHHS) introduced an interruptive pop-up within electronic health workflows, reminding clinicians of the IV fluid shortage and to consider oral hydration.

To evaluate the effectiveness of interruptive pop-up alerts during an acute medication shortage.

YNHHS deployed the pop-up across nine Emergency Departments, prompting clinicians to consider oral hydration when attempting to order IV fluids. We evaluated clinician responses to the decision support alert from inception on October 8, 2024, to January 16, 2025.

A total of 5500 patients received IV fluids during the 15-week study period, of which 5410 (98.4%) were visits that had the pop-up. In week one, 74.7% of clinicians canceled their IV fluid orders after encountering the pop-up. However, effectiveness of the alert declined rapidly. By week 6, only 18.4% of orders were canceled, and week 15, 8.3%. The percent of visits where patients received IV fluids decreased from a baseline of 20.9% to a nadir of 3.4% during the acute phase of the crisis, but had increased to 10.1% by week 15.

Interruptive alerts can be effective for immediate behavior change during acute crises. However, the effect of interruptive alerts diminishes over time due to clinician adaptation. For sustained practice change, pop-ups can be integrated into a broader strategy that includes education, workflow redesign, clinician team engagement, and timely pop-up deactivation.