Hospitals delay exams due to dye shortage, and face new supply chain challenges

Many hospitals and health systems are postponing exams due to shortages of contrast dye, and analysts say supplies are expected to be low during the summer.

Contrast dye is used in imaging, including CT scans, to enable clinicians to see tissues, blood vessels and organs more clearly. GE Healthcare, a major supplier of contrast dye, said production has been hampered because its primary plant is based in Shanghai, which was locked down for weeks. The company has increased production in Shanghai and at a plant in Ireland and is shipping by air to speed delivery.

Hospitals have been delaying scans to conserve supplies of contrast dye for urgent cases. Josh Hilton, senior director and portfolio advisor for imaging and radiation oncology at Premier Inc., said he expects shortages to persist for several weeks.

“It’s going to be a challenge for the near term,” Hilton told Chief Healthcare Executive. “Certainly some relief is coming as suppliers ramp up production. Probably through the next several weeks I would say, it is going to be a challenge.”

Matthew S. Davenport, vice chair of the American College of Radiology (ACR) Commission on Quality and Safety, told Chief Healthcare Executive he expected the shortage to continue for the next few months. Hospitals are postponing many scans now, and he expects that backlog to pose problems, even as supplies begin to improve.

“I’m expecting this to last through the summer,” Davenport said.

Supplies are “extraordinarily low for places that use GE products,” Davenport said. Nationally, contrast dye is used in about 50 million exams each year, he said.

“It’s having a severe impact on healthcare systems in the U.S.,” he said.

Hospitals have dealt with supply chain challenges throughout the COVID-19 pandemic, including critical items such as personal protective equipment. Some hospitals even put out public appeals for donations of wheelchairs and crutches.

Now, the contrast dye shortage raises fresh questions on managing the supply chain, for contrast dye and other items.

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‘Low probability, high-risk event’

Nancy Foster, vice president for quality and patient safety at the American Hospital Association, said the organization has been talking with federal officials about the shortage of contrast dye, along with other key healthcare supplies produced by a relatively small number of manufacturers.

If critical supplies are only manufactured by a few vendors and there’s a disruption, it can pose a risk “to the entire delivery of healthcare,” Foster said.

“Expanding the number of manufacturers needs to be considered thoughtfully,” Foster said.

The shortage stems from an event that, to be fair, is one that isn’t easily predicted: the weeks-long shutdown of Shanghai, a city of 25 million.

“We’re dealing with a low probability, high-risk event,” Davenport said.

Still, the contrast dye shortage underscores the need for hospitals to have a diverse mix of suppliers, he said.

“The reason why this happened is because there are too many eggs in too few baskets,” Davenport said.

In many cases, health systems opt to get all or most of their supplies from one vendor because they get a better price, Davenport noted. If systems don’t get a certain percentage of their supplies from a particular vendor, they won’t get preferred pricing.

The choice of utilizing one or more suppliers for healthcare supplies can be a difficult one, said Meg Wyatt, senior director of diagnostics at Premier Inc.

In the eyes of some, Wyatt said, “If you’re loyal to no one, you’re at the back of the line with everyone.”

In terms of contrast dye, Hilton said health systems have typically been able to order supplies without worry. “It’s just always been there. We’ve had a few shortages that have been very short in duration,” Hilton said.

“This will be an exercise in conservation,” he said.

Hilton said he expected supplies of contrast dye to improve by late summer, and didn’t anticipate shortages lasting into the fall.

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Supply chain solutions

For some healthcare items, a handful of suppliers have a large share of the market, and hospitals need to maintain adequate quantities of “safety stock” in the event of shortages or disruptions, Wyatt said. They also need to look at qualifying secondary sources and review processes for clinical alternatives.

More than ever, healthcare supply managers need to be talking with clinicians about supplies, a lesson some systems have learned during the pandemic.

If supply managers never thought of bedside nurses as part of the supply chain before, Wyatt said, “They do now.”

Health systems should be talking with doctors and nurses to get a sense of what supplies they need, and if there are acceptable substitutes for certain drugs and other products.

On the flip side, hospital supply managers should give as much notice as possible if they need additional supplies from vendors or are making larger orders than normal, Gregg Lambert, senior vice president of Kaufman Hall, told Chief Healthcare Executive last November.

If a vendor expects an order of 50 items and a hospital wants 500, the health system supply manager should give some warning weeks before the order is needed.

“That type of surprise conversation with the vendors is what we really need to avoid in the future,” Lambert said.

Health systems also must be cognizant of where their supplies are being produced.

“Hospitals often don’t know what the sourcing of a product is they’re using. They only know how dependent they are on it,” Foster said.

Some healthcare leaders have talked about the need to find more materials from domestic suppliers or manufacturers who are closer to the U.S.

Manufacturers still should produce supplies at multiple sites, domestically or outside the country, to reduce the risks of disruption, Wyatt said. If a manufacturer is using one plant to produce a key supply, even if it is based in the U.S., “That site is always at risk,” Wyatt said. Companies relying on just one or two plants for supplies face serious problems in the event of severe weather events or cyber attacks.

Hospital leaders need to carefully choose their suppliers and ask critical questions.

“You get to know their products and contracting philosophy,” Lambert said in November. “Take it a step further. Where are they sourcing products? Where will I be on allocation should there be disruption? What will you do with disruption?”

Healthcare leaders should also adopt a different philosophy on costs, Wyatt said.

Hospital leaders need to think about more than just getting the lowest price. They need to choose vendors who can reliably deliver essential supplies, and ask suppliers how they manage disruption.

It doesn’t matter if a vendor offers the cheapest price if the company can’t deliver the supplies when hospitals need them.

“If you source from the most resilient supplier, that’s the most efficient,” Wyatt said.

The contrast dye shortage illustrates the need for better data so healthcare systems can manage their supplies more effectively.

“Until we have really transparent supply and demand data, which will take a long time to build, the willingness to give predictive demand will be more valued,” Wyatt said.