Health Policy and Health Services Research
Background: Medication shortages disproportionately impact EDs due to the time-sensitive nature of care and limited availability of alternatives. We identify the most frequently used medications in U.S. EDs from 2011-2016 and quantify the duration and potential impact of medication shortages since 2016.
Methods: We used the most recent years of the National Health Ambulatory Medical Care Survey to identify the most frequent medications administered in the ED. We calculated the average annual utilization for each medication by summing survey-weighted frequencies, dividing by total years, and then used non-parametric tests to compare correlation of ranks between years to extrapolate current utilization, as 2017-2018 data are not yet available. For each medication, we identified whether a shortage had occurred over between January 1, 2017, and December 24, 2018, then calculated the duration of the shortage in days by cross-referencing the American Society of Health-System Pharmacists (ASHP) and the U.S. Food and Drug Administration (FDA) online drug shortage databases. Drug shortage data were independently abstracted by two trained co-investigators.
Results: Twenty-three total medications appeared among the top 20 most frequently used medications in each year from 2011-16. The Spearman’s rank correlation coefficient ranged from 0.87 to 0.97 (P<0.001 for all pairwise comparisons), demonstrating high consistency between years. Of the 23 medications, 52% (12) have experienced a shortage of the most commonly used formulation in the past two years, including the top two most frequently used medications, 0.9% sodium chloride (729 days, 25.3 million average annual ED visits +/- 2.1 million) and ondansetron (264 days, 21.7 million visits +/- 1.5 million). Median shortage duration was 264 days, and ranged from 11 days (promethazine) to 729 days (0.9% sodium chloride and injectable lidocaine). Based on historical utilization patterns, these shortages would have impacted up to 67.2 million ED visits (+/- 5.5 million) on average per year.
Conclusion: Over half of the most frequently used ED medications have experienced a shortage over the past two years, and the median shortage lasted nearly 9 months, suggesting shortages continue to be widespread and severe. Policy interventions are direly needed to ensure access to the most commonly used medications across U.S. EDs.