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Hospitals around the country are conserving critical intravenous fluid supplies to cope with a shortage that may last months. Some hospital administrators say they are changing how they think about IV fluid hydration altogether.

This story also ran on NPR. It can be republished for free.

Hurricane Helene, which hit North Carolina in September, wrecked a Baxter International facility that produces 60% of the IV fluids used in the U.S., according to the American Hospital Association.

The company was forced to stop production and is rationing its products. In an update posted Nov. 7, Baxter said its North Cove facility had resumed producing some IV fluids. In an email to KFF Health News, the company wrote that customers will be able to order normal quantities of certain IV solutions products by the end of the year, but there is no timeline for when the North Cove facility will be back to prehurricane production levels.

Meanwhile, hospitals are facing seasonal strains on their already limited IV fluid resources, said Sam Elgawly, chief of resource stewardship at Inova, a health system in the Washington, D.C., area.

Weve been very aggressive in our conservation measures, Elgawly said, stressing that he does not believe patient care has been compromised. He told KFF Health News that across the system IV fluid usage has dropped 55% since early October.

Elgawly called the shortage a crisis that he expects to have to continue managing for some time. We are going to operate under the assumption that this is going to be the way it is through the end of 2024 and have adopted our demand/conservation measures accordingly, he said. Email Sign-Up

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At the end of the calendar year, many patients with insurance hurry to schedule surgical procedures before their deductibles reset in January. Elgawly is eyeing that typical surgical rush and the impending peak of respiratory virus season as he tries to stockpile IV fluid bags. Hospitals such as Inovas are using different ways to conserve, such as giving some medications intravenously, but without a dedicated IV fluid bag, known as a push medication.

You don’t even need a bag at all. You just give the medication without the bag, he said. There has been increasing literature over the last 10 to 20 years that indicates maybe you don’t need to use as much. And this accelerated our sort of innovation and testing of that idea.

Monica Coleman is a nurse at a Department of Veterans Affairs hospital in North Chicago. She said using push medications takes more time out of a nurses already hectic schedule because then they need to monitor the patient.

This could increase adverse effects within the patient, because we’re giving the medication at a faster rate, she said.

Elgawly is also interested in retooling electronic health records to question doctor orders for more IV hydration.

Does the patient actually need that second bag? How did they do today with eating or drinking water or juice? They did well? They don’t need the bag. So it’s little conservation mechanisms like that that, when you add them across, you know, the 2,000-patient system that Inova is, make a significant dent, he said.

Simpler conservation measures could become common after the shortage abates, said Vince Green, chief medical officer for Pipeline Health, a small hospital system in the Los Angeles area that serves mainly people on Medicare and Medicaid.

First, Green would like to see data showing that patient outcomes arent affected. But for now, some of the new strategies just make sense to him. He has directed hospital staff to use up the entire IV bag before starting another.

If they come in with IV fluids that the paramedics have started, lets continue it. If it saves half a bag of fluids, so be it, but it adds up over time, he said.

Patients may be asked to take more accountability for their hydration, by drinking Gatorade or water rather than the default of hydrating through an IV, he said.

From an environmental aspect, we don’t need to have this much waste and fill up our landfills. If we could reduce stuff, I think it’d be wise, he said.

But hell feel better when his hospitals receive a full order, which could be weeks away. Green said they are down to a two-week supply, with an expected increase in hospitalizations due to respiratory virus season.

We’re purchasing every IV fluid bag that we can get, he said.

Jackie Fortir: @JackieFortier Related Topics Health Industry States Hospitals North Carolina Contact Us Submit a Story Tip

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Microsoft unveils new voice-activated AI assistant for doctors

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Microsoft unveils new voice-activated AI assistant for doctors

Microsoft is giving its health-care artificial intelligence tools a makeover. 

The company on Monday unveiled a new voice-activated AI assistant that combines capabilities from its dictation solution, Dragon Medical One, and ambient listening solution, DAX Copilot, into one tool.

“Dragon Copilot” will be able to help doctors quickly pull information from medical sources and automatically draft clinical notes, referral letters, post-visit summaries and more, according to the company. It’s Microsoft’s latest effort to help health-care workers cut down their daunting clerical workloads, which are a major source of burnout in the industry.

Clinicians spend nearly 28 hours a week on administrative tasks like documentation, for instance, according to an October study from Google Cloud.

“Through this technology, clinicians will have the ability to focus on the patient rather than the computer, and this is going to lead to better outcomes and ultimately better health care for all,” Dr. David Rhew, global chief medical officer at Microsoft, said Thursday in a briefing with reporters.

Microsoft acquired Nuance Communications, the company behind Dragon Medical One and DAX Copilot, for about $16 billion in 2021. As a result, Microsoft has become a major player in the fiercely competitive AI scribing market, which has exploded in popularity as health systems have been looking for tools to help address burnout. 

AI scribes like DAX Copilot allow doctors to draft clinical notes in real time as they consensually record their visits with patients. DAX Copilot has been used in more than 3 million patient visits across 600 health-care organizations in the last month, Microsoft said.   

Other companies like Abridge, which has raised more than $460 million according to PitchBook, and Suki, which has raised nearly $170 million, have developed similar scribing tools. Microsoft’s updated interface could help it stand out from its competitors. 

Dragon Copilot is accessible through a mobile app, browser or desktop, and it integrates directly with several different electronic health records, the company said. 

Clinicians will still be able to draft clinical notes with the assistant like they could with DAX Copilot, but they’ll be able to use natural language to edit their documentation and prompt it further, Kenn Harper, general manager of Dragon products at Microsoft, told reporters on the call.

For instance, a doctor could ask questions like, “Was the patient experiencing ear pain?” or “Can you add the ICD-10 codes to the assessment and plan?” Physicians can also ask broader treatment-related queries such as, “Should this patient be screened for lung cancer?” and get an answer with links to resources like the Centers for Disease Control and Prevention. 

WellSpan Health, which treats patients across 250 locations and nine hospitals throughout central Pennsylvania and northern Maryland, has been testing out Dragon Copilot with a group of clinicians in recent months. 

One of those clinicians is Dr. David Gasperack, chief medical officer of primary care services at WellSpan. It’s still early days, but Gasperack told CNBC the assistant is easy to use and has been more accurate than Microsoft’s existing offerings. 

“We’ve been asked more and more over time to do more administrative tasks that pull us away from the patient relationship and medical decision making,” Gasperack said. “This allows us to get back to that so we can focus on the patient, truly think about what’s needed.”

Microsoft declined to share the cost of Dragon Copilot but said the pricing structure is “competitive.” It will be easy for existing customers to upgrade to the new offering, the company added.   

Dragon Copilot will be generally available in the U.S. and Canada starting in May, Microsoft said. The roll out will expand to the U.K., the Netherlands, France and Germany in the months following.

“Our goal remains to restore the joy of practicing medicine for clinicians and provide a better experience for patients globally,” Rhew said.

Watch: What it’s like to have a doctor visit with AI

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The crypto law alphabet soup of the UAE

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The crypto law alphabet soup of the UAE

Navigating the UAE’s crypto ecosystem means decoding a maze of acronyms — SCA, VARA, DMCC, ADGM and more.

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Who’s in, who’s out? The ‘coalition of the willing’ that could secure peace in Ukraine

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Who's in, who's out? The 'coalition of the willing' that could secure peace in Ukraine

A “coalition of the willing” could provide boots on the ground in Ukraine in the event of a ceasefire. 

The phrase was a central theme of Sir Keir Starmer’s speech after European leaders gathered in London for crucial talks about Ukraine’s future.

Led by the UK and France, the initiative could see troops from a number of European and NATO countries deployed to Ukraine as peacekeepers in order to deter Vladimir Putin from rearming and attacking again in the future.

Follow latest: Russia not ready to negotiate, Zelenskyy says

Sir Keir said Europe “must do the heavy lifting” on defence and indicated several countries had expressed interest in being part of the coalition.

So who’s in, who’s out – and what’s behind these latest buzzwords?

Ukraine's President Volodymyr Zelensky, Prime Minister Sir Keir Starmer and France's President Emmanuel Macron hold a meeting during a Leaders' Summit on the situation in Ukraine at Lancaster House, London. Picture date: Sunday March 2, 2025.
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The UK, France and Ukraine are leading on developing a peace deal. Pic: PA

What is a coalition of the willing?

The prime minister has said the UK, France and Ukraine will work together on a peace deal that could be presented to the US.

The countries committed to working together on this deal would form a “coalition of the willing”.

Countries in the coalition could end up sending soldiers to act as peacekeepers in Ukraine in the event of a ceasefire.

Military analyst Michael Clarke said: “It has to be a coalition of the willing because you have at least two NATO members – Slovakia and Hungary – who are vetoing anything that Putin would not like… it’s the same with the EU.”

This approach would allow NATO members to act in a group but not under the NATO umbrella, avoiding vetoes from member states who don’t approve or don’t wish to be involved.

Sir Keir’s choice of the term “coalition of the willing” is also interesting. It’s perhaps intended to remind an American audience of a previous use of the same phrase: when the UK, Poland and other countries joined the US invasion of Iraq.

Russia has so far rejected the idea of any NATO or European peacekeeping force in Ukraine.

Map of military personnel by country, based on NATO estimates.
Image:
Map of military personnel by country, based on NATO estimates.

Who’s in?

Sir Keir is being “quite coy about who the willing are”, Prof Clarke said.

The initiative is being led by the UK and France, so it seems a safe bet that both countries would be involved in the coalition.

Both have powerful militaries and the two nations are also the only countries in Europe with nuclear weapons.

“The important thing is that Britain and France are going to lead it because they are the two most important military powers in Europe,” Prof Clarke told Sky News.

It is notable that France’s President Emmanuel Macron originally raised the possibility of French troops in Ukraine last year, when he refused to rule it out.

A F-16 aircraft releases flares during the "Noble Sword-14" NATO international tactical exercise at the land forces training centre in Oleszno, near Drawsko Pomorskie, northwest Poland September 9, 2014. About 1,700 soldiers from Croatia, Estonia, France, the Netherlands, Lithuania, Germany, Norway, Poland, Slovakia, Slovenia, the U.S., Turkey, Hungary, Britain and Italy are participating in the three-week exercise. REUTERS/Kacper Pempel (POLAND  - Tags: POLITICS MILITARY)
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An F-16 aircraft releases flares during a NATO exercise over Poland. Pic: Reuters

The Baltic states – Estonia, Lithuania and Latvia – are also likely to be involved, along with Finland, Prof Clarke says. All four countries are in NATO and share borders with Russia.

Italy could be involved too, Prof Clarke said, though Prime Minister Giorgia Meloni has clashed with Mr Macron over the idea last week.

Not in Europe but a NATO member, Canada seems another potential contributor to the coalition of the willing.

Prime Minister Justin Trudeau, when asked about a potential deployment of troops as part of a peacekeeping force, said yesterday: “Canada has looked at the ways it can best help and as I’ve said a few days ago, everything’s on the table.”

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The Ukraine summit: How the day unfolded

Who’s out?

Prof Clarke said Poland, Spain and Germany are not expected to send troops as peacekeepers, for different reasons.

Poland has one of the strongest militaries in Europe and aims to spend 4.7% of its GDP on defence this year, well above the NATO target.

But it also has a long border with Ukraine and Belarus and is concerned about its own security.

Polish Prime Minister Donald Tusk last month said: “We do not plan to send Polish soldiers to the territory of Ukraine.”

“We will… give logistical and political support to the countries that will possibly want to provide such guarantees in the future, such physical guarantees.”

starmer X meloni
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Italy’s Giorgia Meloni has been critical of plans to send troops to Ukraine

Spain’s foreign minister Jose Manuel Albares said last month that it was “too early at the moment to talk about deploying troops in Ukraine”, in remarks quoted by AFP.

He added: “There is no peace at the moment, and the effort has to be to achieve it as soon as possible.”

Spain’s government has faced a number of crises at home and spends around 1.28% of GDP on defence, well below the NATO 2% target.

As the biggest economy in Europe, Germany is a crucial part of any united response to the Ukraine war.

But a new government has not yet been formed after last month’s elections.

Friedrich Merz, leader of the Christian Democratic Union (CDU) party, at a rally in Munich. Pic: Reuters
Image:
Incoming German Chancellor Friedrich Merz. Pic: Reuters

Outgoing Chancellor Olaf Scholz has previously ruled out sending German troops to Ukraine as peacekeepers.

While his government has provided substantial support to Ukraine since the full-scale invasion, he has been seen by some as hesitant – for example resisting calls to send the vaunted Taurus missiles to Kyiv.

Friedrich Merz, who is expected to replace him as chancellor once the new government is in place, has taken a harder line, including on pledging Taurus missiles, so it remains to be seen if his attitude on deploying troops will also deviate from his predecessor.

‘Coalition of the willing’ is a curious term to revive


Deborah Hayes

Deborah Haynes

Security and Defence Editor

@haynesdeborah

The use of the term “coalition of the willing” to describe the nations that agree to support an international force to help protect any ceasefire deal in Ukraine is interesting and notable.

It could perhaps be an attempt by Sir Keir Starmer to appeal to an American audience as this was the phrase the United States used for its “coalition of the willing” to invade Iraq more than two decades ago.

That intervention ended in disaster, triggering a bloody insurgency and locking the US and its allies into a costly war, despite the successful toppling of Saddam Hussein.

But reviving the words “coalition of the willing” will – if nothing else – remind Washington that London was its biggest and strongest backer when it turned to allies to back its 2003 invasion.

What about America?

The elephant in the room is the biggest contributor to NATO: the US.

For example, of the 5,015 fighter and fighter ground-attack aircraft in NATO, 2,951 of them are from the US, and a further 1,108 are US-made, according to the International Institute for Strategic Studies thinktank.

And America’s military is not just the largest in the world, but its ability to support troops in the field in terms of logistics is very hard to replace.

The coalition of the willing initiative seems designed to show President Donald Trump that Europe is serious about shouldering the defence burden and taking on more responsibility for the defence of Ukraine.

It should be pointed out that while the US is the single biggest donor to Kyiv, Europe as a whole has pledged more, according to the Kiel Institute for the World Economy thinktank.

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The hope seems to be that the coalition of the willing initiative would persuade the US as the world’s most powerful military to pledge support as a backstop, to underwrite the peace deal.

It’s unclear so far what Washington’s response will be, particularly after the fiery recent meeting between Mr Trump, vice president JD Vance and Mr Zelenskyy.

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