While the national spotlight on the IV fluid shortage has largely focused on hospitals, a quieter crisis is unfolding in the shadows. It is understandable why hospitals dominate the news: they are large, visible, and canceled surgeries demand immediate public attention. However, thousands of outpatient facilities depend on these exact same critical supplies. When inventories run thin, these essential clinics are left to navigate the exact same crisis—often with far less support and visibility.

Who is actually absorbing the impact?

• Infusion centers
• Ambulatory surgery centers
• Pain management clinics
• Outpatient oncology practices

For these facilities, IV fluids are a daily necessity. When treating patients on strict, time-sensitive schedules, a one-week delay isn’t a logistical inconvenience—it is a severe clinical setback.

But unlike massive hospital networks equipped with dedicated supply chain teams, sprawling warehouses, and immense purchasing power, these clinics are fighting a different battle. They are navigating a national crisis armed with little more than a single procurement coordinator, a phone, and a rapidly shrinking list of vendors willing to return their calls.

The Shortage Is Not Over

When Hurricane Helene damaged Baxter International’s North Cove manufacturing facility in September 2024, it knocked out roughly 60 percent of the country’s large-volume IV fluid production. Baxter restored production to approximately 85 percent of pre-storm capacity by December 2024, but the ripple effects continued well into 2025. An ASHP survey on sterile fluid shortages found that 84 percent of pharmacy teams reported moderate or critical impact. Some hospitals saw a 50 percent reduction in available IV products.

For outpatient facilities, the math is worse. Hospitals have buffer stock, central distribution networks, and the purchasing volume to stay at the front of allocation queues. Outpatient centers typically operate on just-in-time inventory models with limited storage. When a manufacturer puts a product on allocation, the facilities with the smallest historical purchase volumes are the first to get cut. That often means the infusion center running 30 chairs, not the 400-bed hospital down the road.

The Costs Nobody Talks About

The direct cost of the shortage, paying more per bag when supply is tight, is the part that shows up on a budget spreadsheet. The hidden costs are bigger. Research published in the American Journal of Emergency Medicine examined how the 2024 IV fluid shortage affected emergency department operations, finding measurable impacts on patient flow and resource utilization. But outpatient facilities face a different set of consequences that rarely get studied.

The true cost goes far beyond lost revenue.

When an infusion center runs out of saline, the financial hit from canceled appointments is just the beginning. The fallout cascades through every level of the practice:

• Wasted Resources: Staff burn hours desperately calling suppliers instead of managing care.
• Clinical Friction: Providers lose critical time evaluating whether alternative fluids are safe for specific regimens.
• Shattered Trust: Patients drive an hour for life-saving chemotherapy, only to be turned away at the door.

For oncology patients, the stakes couldn’t be higher. A delayed infusion isn’t like rescheduling a routine dental cleaning—it directly threatens treatment efficacy and risks disease progression.

During the shortage, MUSC Health proved that conservation protocols work. In fact, their outpatient surgery centers achieved the largest reductions in fluid use across their system.

It is a fantastic success story. But it also exposes two uncomfortable truths:

1. It reveals just how much unnecessary fluid was being consumed before the crisis forced a reckoning.
2. It highlights a terrifyingly thin margin of error. Clinics without MUSC’s robust clinical infrastructure simply do not have the resources to pivot that quickly when the well runs dry.

What Outpatient Facilities Can Do Differently

The facilities that navigated the shortage best shared a few common traits. First, they had diversified their sourcing before the crisis. Maintaining active purchasing relationships with at least two IV fluid suppliers meant they qualified for allocation from multiple sources when Baxter’s supply contracted. Second, they had already evaluated which patients and procedures genuinely required large-volume IV fluids and which could safely transition to oral hydration, smaller flush volumes, or subcutaneous alternatives.

Third, they tracked their IV therapy supplies holistically. That means monitoring not just bags and solutions, but administration sets, extension tubing, catheters, and start kits as an integrated system. A shortage of any single component in that chain can halt an infusion just as effectively as running out of saline. ASHP’s conservation guidelines recommend evaluating whether fluids used to administer secondary infusions are being counted in overall inventory, a detail that many outpatient facilities overlook entirely.

Finally, the most prepared facilities established clinical protocols for fluid conservation before a shortage forced them to improvise. The Anesthesia Patient Safety Foundation published specific guidance during the crisis, including recommendations to avoid pre-spiking bags in anticipation of use, develop substitution policies based on product availability, and evaluate extending hang times for IV solutions. Outpatient facilities that adopted these practices in advance did not have to build protocols while simultaneously managing patients and rationing supply.

The Next Shortage Will Find the Same Gaps

Baxter’s plant is running again. Fluid availability has improved. The temptation for outpatient facilities is to move on and go back to the way things were. That’d be a mistake.

The structural vulnerabilities that made the 2024 shortage so damaging, concentrated manufacturing, just-in-time inventory models, single-source procurement, and limited clinical substitution protocols, haven’t been fixed. The next disruption could be a tariff, a quality recall, or another weather event. Outpatient facilities that use this window to diversify their sourcing, formalize their conservation protocols, and build redundancy into their IV supply chain won’t eliminate the risk. But they will be treating patients on the day their competitors are making phone calls.