Reducing Disposable Surgical Items: Decreasing Environmental Impact and Costs at a Children's Hospital, A Pilot Study

Solutions for Reducing Perioperative Supply Waste

Health care costs continue to increase in the United States, and unused perioperative supplies can contribute to both these costs and increased waste. Reducing perioperative waste can decrease hospital costs and promote sustainability. Perioperative leaders can consider a variety of solutions to decrease unused perioperative supplies, including streamlining and standardizing surgical packs, implementing surgeon scorecards and a surgical receipt system, and updating surgeon preference cards. The available literature does not provide data on waste reduction for all listed solutions; however, these initiatives have had positive financial effects for hospitals through either direct cost reduction or cost avoidance. Although the cost of implementation may vary among hospitals, streamlining surgical packs (including custom packs) appears to be an effective solution with a lower cost than other strategies, and avoids the wasting of opened supplies that are not needed.

[Outcomes of using Pulse Point Arrow as lean healthcare tool for managing paediatric patient safety in the surgical area]

OBJECTIVE

To improve the safety's management in the urology paediatric surgical process of the Ambulatory Major Surgery Unit (AMSU) through the use of this tool.

MATERIAL AND METHODS

Observational study lasting 9 months divided into a PRE-period for collecting information on the safety indicators defined by the team and reflected in the Pulse Point Arrow, using the "Hoja de Ruta", an intervention period and a POST collection stage of the same information.

RESULTS

In both periods, a total of 1464 "Hojas de Ruta" were collected in the CMA unit, 55.8% of the total corresponding to the PRE-period, and the rest to the POST. The selected indicators improved significantly, highlighting the correct placement of bracelets, bed assignment, allergy registration, and administration of preoperative treatment.

CONCLUSIONS

The use of new management tools in healthcare systems is essential for improving healthcare processes and achieving better health outcomes. In our experience the introduction of Pulse Point Arrow improved results of surgical safety of the paediatric patient.

Scoping review for the SAGES EAES joint collaborative on sustainability in surgical practice

BACKGROUND

Surgical care in the operating room (OR) contributes one-third of the greenhouse gas (GHG) emissions in healthcare. The European Association of Endoscopic Surgery (EAES) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) initiated a joint Task Force to promote sustainability within minimally invasive gastrointestinal surgery.

METHODS

A scoping review was conducted by searching MEDLINE via Ovid, Embase via Elsevier, Cochrane Central Register of Controlled Trials, and Scopus on August 25th, 2023 to identify articles reporting on the impact of gastrointestinal surgical care on the environment. The objectives were to establish the terminology, outcome measures, and scope associated with sustainable surgical practice. Quantitative data were summarized using descriptive statistics.

RESULTS

We screened 22,439 articles to identify 85 articles relevant to anesthesia, general surgical practice, and gastrointestinal surgery. There were 58/85 (68.2%) cohort studies and 12/85 (14.1%) Life Cycle Assessment (LCA) studies. The most commonly measured outcomes were kilograms of carbon dioxide equivalents (kg CO2eq), cost of resource consumption in US dollars or euros, surgical waste in kg, water consumption in liters, and energy consumption in kilowatt-hours. Surgical waste production and the use of anesthetic gases were among the largest contributors to the climate impact of surgical practice. Educational initiatives to educate surgical staff on the climate impact of surgery, recycling programs, and strategies to restrict the use of noxious anesthetic gases had the highest impact in reducing the carbon footprint of surgical care. Establishing green teams with multidisciplinary champions is an effective strategy to initiate a sustainability program in gastrointestinal surgery.

CONCLUSION

This review establishes standard terminology and outcome measures used to define the environmental footprint of surgical practices. Impactful initiatives to achieve sustainability in surgical practice will require education and multidisciplinary collaborations among key stakeholders including surgeons, researchers, operating room staff, hospital managers, industry partners, and policymakers.

Practice 'safe scans': why ultrasound transducer covers should be considered best practice

Single-injection, ultrasound-guided nerve block procedures involve puncturing the skin in close proximity to an ultrasound transducer, creating a potential vector for transmission of microbial organisms when skin flora and blood come into contact with the probe. Practice patterns regarding disinfection of the transducer and the use of barrier protection are inconsistent, ranging from sterile sleeve probe covers to no cover at all. Although sleeve probe covers are easy and straightforward to use and serve to protect patients, providers and medical equipment, their utilisation remains controversial. Standardisation of their use eliminates the impact of improper or haphazard probe disinfection and makes infection control practices consistent and reproducible. This position is shared by multiple societies and authorities on ultrasound and acute care medicine. In this Daring Discourse, we outline the arguments supporting the utilisation of single-use sleeve probe covers to ensure patient safety with respect to vector-borne transmission of microbes during single-injection regional anaesthesia procedures.

Tracing the barriers to decarbonising ophthalmology: A review

As climate change demands increasingly urgent mitigation of greenhouse gas emissions, the health sector needs to do its part to decarbonise. Ophthalmologists share concerns about climate change and seek opportunities to reduce their environmental impact. When measuring the footprint of ophthalmology, major contributions are from patient travel to clinics, and from the large amounts of single-use disposable materials that are consumed during surgeries and sterile procedures. Ophthalmic services in India have already demonstrated systems that consume far fewer of these products through efficient throughput of patients and the safe reuse of many items, while maintaining equivalent safety and quality outcomes. Choosing these low-cost low-emission options would seem obvious, but many ophthalmologists experience barriers that prevent them operating as Indian surgeons do. Understanding these barriers to change is a crucial step in the decarbonisation of ophthalmology and the health sector more broadly.