June 3, 2022

A Message for the Tufts Medicine Integrated Network, including primary and specialty care physicians, practice administrators and other Network leaders

Update on Worldwide Shortage of Iodinated Contrast

Tufts Medicine continues to be affected by a global shortage of iodinated contrast media. One of the primary manufacturers of contrast is experiencing shortages due to reduced manufacturing capacity and freight delays caused by the recurrent COVID-19 lockdown in Shanghai, China. While it is hoped that the normal supply will resume in mid or late-June 2022, it appears likely that the shortage may stretch into September.
These contrast agents are used in a variety of clinical procedures, including CT exams, angiograms, and many interventional procedures. All Tufts Medicine entities, including Lowell General Hospital, Tufts Medical Center and MelroseWakefield Hospital, are impacted by the supply chain interruptions.
What’s New This Week
Through careful stewardship, all entities across Tufts Medicine have been successful in significantly reducing contrast usage. This includes use of alternative non-contrast studies, tailoring of individual doses to reduce waste, deferral of routine studies, and use of alternate imaging modalities. The result is a 52.27% reduction in contrast use compared with pre-shortage levels. This reduction in usage will help us preserve contrast for the most critical cases throughout the duration of the shortage.
Given our successful preservation efforts, the allocated contrast supply from both GE and Bracco has been sufficient to support current procedure volume. This week, GE announced that its Shanghai plant will be at 100% production capacity by early next week, which is much earlier than originally anticipated. That said, deliveries continue to be sporadic, and we continue to keep a close watch on contrast stores and burn rates to ensure that the recommended restrictions are adequate to protect our limited supply. We also continue to treat our entity-level contrast inventories as a Tufts Medicine system-wide supply and have successfully transferred some contrast from one entity to another, as needed.  
Additionally, members of our system-wide Incident Command Team have worked with a number of internal partners to:
1.    Create a common message about the shortage to be used with patients in each of our entities. While we work to understand translation requirements, we have posted the English versions for each entity on our Tufts Medicine website. You can download and print them here.
2.    Create a new SmartPhrase in Epic called RISCONTRASTSHORTAGE that will enable clinicians to easily note that the patient was seen during a time of contrast shortage. See instructions* below. 
3.    Build tools that share inventory and usage data across the system, so that we can manage this collaboratively as a system to strike the right balance between appropriate clinical care and conservation of our supply.

Action Required 
As a reminder, all ordering clinicians and care teams are encouraged to adhere to the Tufts Medicine Guidelines and order non-contrast CT exams judiciously when clinically appropriate. Radiologists are available to discuss alternatives to iodinated contrast and will ultimately determine when contrast is used. 

We will continue to monitor and report to you on this shortage, and the actions we are taking to address it. Thank you for your patience and understanding as we work together through this challenging situation.

Please contact your organization’s Chief Medical Officer with any additional questions. 

Michael Wagner, MD, FACP 
Chief Physician Executive 
Tufts Medicine 
*When you click the My Phrases button within a note, you can select the System SmartPhrases option on the right side of the screen and search for the phrase RISCONTRASTSHORTAGE. Favoriting this phrase will keep it at the top with your personal SmartPhrases when you have both the System and My SmartPhrases boxes checked (see below).
The Tufts Medicine Integrated Network is a distinctively different population health enterprise and value-based care contracting entity. It comprises 2,300 primary care and specialist physicians and advanced practice clinicians, working as Tufts Medicine employees or in private practice, delivering care in community and hospital settings. The Network’s purpose is to build healthier communities and to create healthy, rewarding experiences for our members and care teams. The Network was launched in July 2021 by building upon the legacies of two long-standing, high-performing organizations – Lowell General Physician Hospital Organization and New England Quality Care Alliance (NEQCA).

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