Ontario hospitals facing critical shortage of blood collection tubes

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Some hospitals are telling staff to conserve supplies and reconsider the number of blood tests they order as fears grow about prolonged shortages.

Original author: Megan Ogilvie

Published: February 15, 2022

Source: thestar.com

Ontario hospitals are facing a critical shortage of collection tubes required for routine blood work, forcing some hospitals to direct staff to conserve supplies and reconsider the number of blood tests they order for patients.

But even with conservation strategies in place, some clinicians and laboratory staff are concerned that prolonged shortages or a significant disruption in supplies could affect patient care.

They warn the shortages add another challenge to hospitals stretched by pandemic pressures, and say monitoring the supply of blood collection tubes will be even more important as hospitals reopen operating rooms to scheduled surgeries that had been paused during the Omicron wave.

“It’s not a stable situation by any means,” said Dr. Catherine Streutker, chief and medical director of laboratory medicine at Unity Health Toronto. “Right now, we’re OK. But we expect this is going to be a difficult situation for some months.

“These shortages affect the majority of blood tests done in the hospital, and if we’re not able to do them, there is potential for it to harm patient care.”

The shortage of blood collection tubes — linked to global supply-chain stressors — started to affect hospitals in late December and has intensified in recent weeks, Streutker said.

At the end of January, Unity — which includes St. Michael’s Hospital and St. Joseph’s Health Centre — was down to a few days’ supply of blood collection tubes and needed to ask neighbouring hospitals for help. A memo sent to staff Jan. 31 outlining the supply concerns stated the network “was in a crisis,” said Streutker, noting that warning triggered a 10 per cent reduction in the use of the tubes at the hospital.

“I am concerned about surgeries ramping up; that will increase utilization of these tubes, which will mean we’ll run out faster if we cannot get supply.”

Dr. Fahad Razak, a general internist at St. Michael’s, called blood work a “cornerstone of providing medical care” that is critical for diagnosing, assessing and treating most hospitalized patients.

“In my career, there has never been a time where routine blood work — the very core of our testing — has been threatened,” he said. “Right now, it’s affecting hospitals across the sector. But the supply that’s used for blood testing is the same that’s used by family doctors … And so this will affect medical care in general if we run out of the supplies.”

The blood collection tubes in short supply are known as vacutainers. The sterile glass or plastic tubes with coloured rubber stoppers are used for routine blood work in hospitals and in community-based laboratory centres.

In a statement to the Star, the global medical technology company BD (Becton Dickinson and Co.), a blood tube supplier used by some Ontario hospitals, noted the pandemic has challenged supply chains and said COVID has led to “constantly changing demand for the types and volumes of tests needed.”

To respond to the increased demand for blood tubes, the company boosted its manufacturing abilities and produced “nearly a half billion additional blood tubes in 2021 versus 2020,” a spokesperson said, adding BD will “produce more tubes in the next 12 months than ever before.”

The spokesperson added the limited availability of raw materials, labour shortages and shipping and transportation delays has limited the company’s ability to boost production even higher.

Lisa Merkley, operations director of laboratory services at Sunnybrook, said BD notified the hospital in late December that it foresaw supply challenges with its blood tubes. And while the company was doing its best to allocate supplies to hospitals, it has not been enough to meet the hospital’s demands, she said.

That has led to Sunnybrook adopting strategies to reduce the use of blood tubes, said Dr. Adina Weinerman, medical director of quality and patient safety and a staff physician in general internal medicine.

“We are working in a resource-constrained environment, and this is different than what you are used to, and we need you to be aware that the amount of blood work ordered across the board needs to decrease,” said Weinerman, describing the messaging being provided to the hospital’s physicians.

While Sunnybrook has not instituted specific benchmarks for a reduction in blood work, Weinerman said the hospital is following recommendations by Choosing Wisely Canada, an evidence-based health education campaign designed to reduce unnecessary tests, treatments and procedures. She said there is evidence that suggests up to 60 per cent of blood work done for hospitalized patients is “medically unnecessary” and that some studies show the amount of blood draws done in such patients can cause harm.

“Studies show we can safely decrease the amount of blood work we do without causing adverse events,” she said.

On Feb. 10, Health Canada notified manufacturers and suppliers they must report shortages of blood collection tubes so the agency can “confirm the actual or potential shortage status of this device,” a spokesperson said. The notification was triggered through Health Canada’s mandatory medical device shortage reporting, introduced in 2020 in response to increased demand for medical devices during the pandemic, the statement said.

Marilyn Spagnoli, director of laboratory medicine and diagnostic imaging at Michael Garron Hospital, said in a statement that hospitals across North America are facing supply challenges with vacutainers, in part due to the surge in COVID patient volumes leading to an increased demand for laboratory medicine and blood collection services.

She noted while it “is a concerning challenge,” the hospital is “not currently experiencing disruptions to patient care services as a result of this shortage.” Spagnoli added the hospital has contingency plans, and efforts to conserve tubes and supplies are supported by Choosing Wisely Canada recommendations.

Streutker of Unity Health agrees the public should know about these critical shortages and said family doctors should also be aware of the issue “and take care with their ordering.”