The purchase order was confirmed three weeks ago. This morning the acknowledgment came back: backordered, no estimated ship date. The OR schedule, the infusion center and the med-surg floor are not waiting three weeks. In ECRI's October 2023 survey of about 200 respondents, 60 percent reported shortages of 20 or more drugs, supplies or devices in the prior six months, half reported delayed patient treatments, and one in four knew of at least one shortage-related error. Premier's 2023 resiliency survey found nearly half of providers canceled or rescheduled cases at least quarterly in 2022 because of product shortages. A backorder is a clinical event with a procurement cause. Here is how to work it so the care schedule holds.
Confirm what kind of backorder you have
Not every "backordered" line is a national shortage. Most are one of three problems, and each has a different fix.
| Backorder type | How to tell | First move |
|---|---|---|
| Distributor stockout | The manufacturer is shipping; your distributor's DC is empty | Ask for a transfer from another DC, or buy the same SKU through a second distributor |
| Manufacturer allocation | You receive a percentage of historical usage, and so does everyone else | Get the allocation letter, confirm your baseline, and qualify an equivalent now |
| National shortage | The product code is on the FDA Medical Device Shortages List or the FDA drug shortage database | Conserve, substitute, and report the gap to FDA |
Check the FDA list first. Its June 16, 2026 update names the device categories FDA has determined to be in shortage, including neurosurgical patties, stereotactic breast biopsy needles, angiographic control syringes, endoscopic vessel harvesting systems and oxygenators for extracorporeal circulation. FDA notes that a device type on the list does not necessarily mean patient care has been affected. The list tells you supply is tight nationally, not whether your facility will run out.
If a device you cannot get is not on the list, tell FDA. The agency says it wants to hear from health care facilities and providers having difficulty obtaining medical devices, and anyone can report to deviceshortages@fda.hhs.gov. Outside a declared public health emergency, manufacturer notifications to FDA are voluntary, so a report from your facility matters.
Qualify the equivalent before the shelf is empty
The Minnesota Department of Health's November 2024 fluid allocation framework sets the bar buyers should hold substitutes to: care may be delivered differently, but outcomes should be substantially comparable to conventional conditions. It calls for using alternative brands where possible and substituting similar isotonic crystalloids for one another depending on availability. The same logic applies to devices. A substitute is qualified when it matches the original on the attributes that affect clinical use, not when it has a similar name.
Ask for these on any substitute quote:
- Same FDA product code and 510(k) clearance, or the reason it does not need one
- Matching specifications: size, gauge, sterility, latex status, material, packaging unit
- Instructions for use, side by side with the incumbent item
- Lot number, expiration date and country of origin on the quote, not after delivery
- Sign-off from the clinical owner (OR manager, pharmacy, infection prevention) before the PO
Neurosurgical patties, on FDA's June 2026 shortage list, are the working example: a surgeon who has used one brand for a decade will notice a change in marker placement or edge finish. Keystone quotes alternates in the surgical and procedure category with the specification sheet attached, so the clinical owner can approve or reject before anything ships.
Conserve without cutting care
ASPR TRACIE's October 2024 IV fluid strategies, written during the Baxter disruption, are the best checklist for stretching any constrained consumable. Its general strategies: centralize stock and minimize par levels on non-critical units; provide fluids by need and acuity rather than empirically; move fluid management to oral and enteral forms where possible; match the bag to the dose (a 500 mL bag instead of a 1,000 mL bag when the smaller size is in supply); and do not use "keep open" lines or orders. It also tells systems to communicate with suppliers about ongoing needs and product availability, and to document in the medical record when a treatment was adapted.
MDH adds two practical rules: do not swap a running bag for a different fluid when a patient moves from the ED to an inpatient unit, and treat postponing non-emergent procedures as the step you take only when other measures cannot preserve supply.
For buyers, conservation is a purchasing lever. Every 500 mL bag you can substitute for a 1,000 mL bag is a line you can source from a different manufacturer's run. Keystone's IV and infusion category quotes bag sizes, administration sets and flush syringes across manufacturers, so the conservation plan and the sourcing plan match.
What the North Cove disruption taught procurement
When Hurricane Helene flooded Baxter's North Cove, North Carolina plant in late September 2024, the site had been making about 60 percent, roughly 1.5 million bags a day, of the IV fluids used in the U.S., according to the AHA. Baxter returned to pre-hurricane production in February 2025 and did not remove allocations on virtually all North Cove IV product codes until May 13, 2025. That is more than seven months of allocation on the highest-volume consumable in the building.
Two buyer lessons came out of it. First, extended dating is real supply. In October 2024, FDA authorized Baxter to extend expiration dates to 24 months from manufacture, without relabeling, for product codes made before September 30, 2024. Facilities that checked Baxter's code list before discarding short-dated stock kept product on the shelf. Second, a single-source category is a single point of failure, and the day to open a second account is not the day the primary goes on allocation.
Put the second source on file now
Vendor setup is where backorder response loses days. A W-9, a state tax exemption certificate, a certificate of insurance and a credit application move slowly through accounts payable when nobody is in a hurry. Do it before the shortage, and send the second source a small order once a year so the account stays active.
Keystone Supply Group was built for this seat. From the Edina, Minnesota office and warehouse at 7330 Ohms Lane, we quote 58,000+ SKUs across 270+ manufacturer relationships, return quotes the same business day, and ship stocked items in 1 to 3 business days. Approved accounts get Net 30, and U.S. orders of $500 or more ship free economy. Since August 2025 we have shipped 21M+ units to customers in 26 states. Every substitute quote carries lot, expiration and country-of-origin data. See how the shortage sourcing desk works, or send the backorder report as it stands.
Explore the catalog or Request a quote with your backordered lines and required-by dates. Call (507) 237-6036 or email Orders@KeystoneSupplyGroup.com.
Sources
- FDA, Medical Device Supply Chain and Shortages: https://www.fda.gov/medical-devices/medical-device-safety/medical-device-supply-chain-and-shortages
- FDA, Medical Device Shortages List: https://www.fda.gov/medical-devices/medical-device-supply-chain-and-shortages/medical-device-shortages-list
- ASPR TRACIE, Intravenous Fluid Shortage Strategies (October 9, 2024): https://files.asprtracie.hhs.gov/documents/iv-fluid-shortage-strategies.pdf
- Minnesota Department of Health, Recommendations for Ethical Allocation of Sterilized Fluids (November 26, 2024): https://www.health.mn.gov/communities/ep/surge/crisis/ivfluids.pdf
- Baxter, Hurricane Helene Summary (May 13, 2025): https://www.baxter.com/baxter-newsroom/hurricane-helene-updates
- American Hospital Association, Baxter Announces Expiration Dating Extensions for Certain IV Products (October 28, 2024): https://www.aha.org/2024-10-28-baxter-announces-expiration-dating-extensions-certain-products-related-iv-solutions-disruption
- ECRI, Medication, Supply, Equipment Shortages are Harming Patients (October 13, 2023): https://home.ecri.org/blogs/ecri-news/medication-supply-equipment-shortages-are-harming-patients
- Premier, New Premier Data Highlights Healthcare Supply Chain Landscape, Challenges and Strategies for Success: https://premierinc.com/newsroom/blog/new-premier-data-highlights-healthcare-supply-chain-landscape-challenges-and-strategies-for-success
