May 13, 2022

A message for all Tufts Medicine Employed Clinicians and Tufts Medicine Integrated Network Members, including primary and specialty care physicians, practice administrators, and other Network leaders

Update on Worldwide Shortage of Iodinated Contrast

Background
COVID-19 related production and transportation issues have resulted in a world-wide critical shortage of iodinated IV contrast. 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. We have activated a system-wide Incident Command Team with representation from all entities to work together. Current information is that we will receive approximately 20% of our normal shipment from one of our providers. This will likely span through the summer. This shortage has made a significant impact on patient care. 
 
What’s New This Week
Over the past week, clinical leaders from across Tufts Medicine have worked together to address the shortage.
 
  • Our leadership team has developed clinical guidelines that outline how you should change your practice to preserve contrast for the patients who need it most. 

  • Pharmacy has successfully made packaging changes to reduce waste and conserve current supplies. Contrast vials are being broken down into smaller sterile units and distributed to end users based on need. This has resulted in preservation of usable contrast that would have otherwise gone to waste.

  • Radiology has developed guidelines to substitute non-contrast examinations and/or alternative imaging modalities such as ultrasound and MRI to reduce use. These have been successfully implemented at Lowell General Hospital and MelroseWakefield Hospital over the past week, and are now being introduced at Tufts Medical Center.

  • Cardiology and Interventional Radiology have implemented contrast preserving measures, including use of substitute agents such as carbon dioxide, non-invasive evaluations with nuclear medicine or ultrasound, and deferral of routine exams.

  • Our current contrast supply continues to be treated as Tufts Medicine inventory and will be shared across the system according to need. The supply chain team is closely monitoring our stores and working on analytics to track burn rates and accurately estimate days on hand based on demand. 
 
Action Required 
Efforts to date have been successful in a large part due to the cooperation of the affected clinical services and excellent communication between care teams. Your continued assistance and judicious use of contrast exams are essential to successfully navigate through this crisis. The limits to our supply are severe. Without conservation measures, we will all be without contrast within a month. All ordering clinicians and provider teams are encouraged to 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. 
 
Sincerely,
Michael Wagner, MD, FACP
Chief Physician Executive
Tufts Medicine
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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