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Matthys M, Wang J, Sathe TS, Wang K, Gandhi S, Lee H, Alseidi A. Needs Assessment for the Development of a Sustainability Curriculum for Surgical Residents. JOURNAL OF SURGICAL EDUCATION 2024; 81:1437-1445. [PMID: 39129111 DOI: 10.1016/j.jsurg.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 06/28/2024] [Indexed: 08/13/2024]
Abstract
INTRODUCTION The healthcare sector accounts for 8.5% of United States (U.S.) greenhouse gas emissions, of which one-third comes from operating rooms (ORs). As a result, there is great interest in decarbonizing the OR and surgical care. However, surgical residents are not routinely educated on the negative environmental impact of surgery or how to reduce it. In this paper, we present a formal needs assessment for a sustainability curriculum geared towards surgical residents. METHODS Using Kern's Six-Step Framework for curriculum development, we conducted focus groups with surgical residents to perform a targeted needs assessment on 3 main topics: 1) the current state of surgical sustainability curricula; 2) resident knowledge regarding the environmental impact of surgery and barriers to sustainable practice; and 3) preferred educational methods and topics within sustainability education. We audio-recorded all focus groups and performed thematic analysis using anonymized transcripts. RESULTS Fourteen residents participated in 3 focus groups, from which a qualitative analysis revealed 4 themes. First, surgery residents receive limited formal teaching on the negative environmental impact of surgical care or how to reduce this impact. Second, surgery residents have variable levels of prior education about and interest in sustainability in surgery. Third, several barriers prevent the implementation of sustainable changes in surgical practice, including a lack of institutional initiative, cultural inertia, concerns about workflow efficiency, and limited formal education. Finally, residents prefer to learn about practical ways to reduce waste, specifically through interactive approaches such as quality improvement initiatives. CONCLUSIONS Given the increasing importance of sustainability in surgery, there is an urgent need for formal resident education on this topic. This needs assessment provides a valuable foundation for future sustainability curriculum development.
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Affiliation(s)
- Madeline Matthys
- Department of Surgery, University of California, San Francisco, CA.
| | - Jane Wang
- Department of Surgery, University of California, San Francisco, CA
| | - Tejas S Sathe
- Department of Surgery, University of California, San Francisco, CA
| | - Kaiyi Wang
- Department of Surgery, University of California, San Francisco, CA
| | - Seema Gandhi
- Department of Anesthesia, University of California, San Francisco, CA
| | - Hanmin Lee
- Department of Surgery, University of California, San Francisco, CA
| | - Adnan Alseidi
- Department of Surgery, University of California, San Francisco, CA
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Bakhshi M, Mollazadeh S, Alkhan M, Salehinia R, Parvizi M, Ebrahimi Z. Investigating the sterile surgical supply waste in laparotomy surgery. BMC Health Serv Res 2024; 24:1048. [PMID: 39261886 PMCID: PMC11389253 DOI: 10.1186/s12913-024-11497-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 08/27/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Operating rooms contribute to over 40% of hospital expenses, with a portion attributed to waste from single-use, sterile surgical supplies (SUSSS). This research aimed to determine the amount of cost wastage due to not using SUSSS during laparotomy procedures. METHODS A descriptive-analytical investigation was conducted in two prominent teaching hospitals in Mashhad, Iran 2018. Seventy-seven laparotomy surgeries were scrutinized, documenting both used and unused disposable devices, with their respective costs being assessed. Data analysis was performed using SPSS version 16 software. RESULTS The study revealed that during surgery in the operating rooms, waste of SUSSS averaged 5.9%. Betadine solution and sterile Gauze types were the top two contributors to resource wastage. Sterile Gauze types incurred the highest cost loss. The study found a significant correlation between cost wastage and surgeon experience (r = 0.296, P < 0.001) as well as surgery duration (r = 0.439, P < 0.001). CONCLUSION Inadequate management of available and commonly used disposable supplies leads to increased hospital expenses. Enhancing the surgical team's knowledge of sterile surgical supplies usage and making thoughtful selections can play a vital role in curbing health costs by minimizing waste of SUSSS in the operating rooms.
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Affiliation(s)
- Mahmoud Bakhshi
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Sanaz Mollazadeh
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Alkhan
- Department of Operating Room and Anesthesia, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Salehinia
- Department of Operating Room and Anesthesia, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Parvizi
- Department of Operating Room and Anesthesia, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Ebrahimi
- Department of Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
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Pillay L, Winkel KD, Kariotis T. Developing the green operating room: exploring barriers and opportunities to reducing operating room waste. Med J Aust 2024; 221:279-284. [PMID: 39039604 DOI: 10.5694/mja2.52394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/11/2024] [Indexed: 07/24/2024]
Abstract
The Australian health care system contributes 7% of the national greenhouse gas emission footprint and generates massive waste streams annually. Operating rooms are a particular hotspot, generating at least 20% of the total hospital waste. A systematic search of several global academic databases was conducted in mid-2022 (articles from 1992 to 2022) for peer-reviewed research relevant to waste management in the operating rooms. We then used thematic analysis to enumerate and characterise the strategies and barriers to sustainable waste management in the operating room. The waste reduction strategies focused on avoidance of high carbon products; correct waste segregation and reduced overage; reusing, reprocessing, and repurposing devices; and improved recycling. The first barrier identified was a constrained interpretation of the concept of "first do not harm", ingrained in surgeons' practices, in prioritising single-use surgical products. The second barrier was ineffective or insufficient waste education. The third barrier was the immediate cost of implementing waste management compared with the long term realisation of environmental and economic benefits. The last barrier to implementing institutional practice change was the lack of policies and regulations at the local hospital, federal and international levels. We also evaluated the knowledge gaps in current surgical waste research, including lack of benchmarking data and standardised regulations concerning reusable or reprocessed devices, as well as the methods used to promote pro-sustainability behavioural change.
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Affiliation(s)
| | - Kenneth D Winkel
- Centre for Health Policy, University of Melbourne, Melbourne, VIC
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Sathe TS, Alseidi A, Bellato V, Ganjouei AA, Foroutani L, Hall RP, Potapov O, Bello RJ, Johnson SM, Marconi S, Francis N, Barach P, Sanchez-Casalongue M, Nijhawan S, Oslock WM, Miller B, Samreen S, Chung J, Marfo N, Huo B, Lim RB, Vandeberg J, Alimi YR, Pietrabissa A, Arezzo A, Frountzas M, Rems M, Eussen MMM, Bouvy ND, Sylla P. Perspectives on sustainability among surgeons: findings from the SAGES-EAES sustainability in surgical practice task force survey. Surg Endosc 2024:10.1007/s00464-024-11137-7. [PMID: 39160314 DOI: 10.1007/s00464-024-11137-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 08/01/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND Surgical care significantly contributes to healthcare-associated greenhouse gas emissions (GHG). Surgeon attitudes about mitigation of the impact of surgical practice on environmental sustainability remains poorly understood. To better understand surgeon perspectives globally, the Society of American Gastrointestinal and Endoscopic Surgeons and the European Association for Endoscopic Surgery established a joint Sustainability in Surgical Practice (SSP) Task Force and distributed a survey on sustainability. METHODS Our survey asked about (1) surgeon attitudes toward sustainability, (2) ability to estimate the carbon footprint of surgical procedures and supplies, (3) concerns about the negative impacts of sustainable interventions, (4) willingness to change specific practices, and (5) preferred educational topics and modalities. Questions were primarily written in Likert-scale format. A clustering analysis was performed to determine whether survey respondents could be grouped into distinct subsets to inform future outreach and education efforts. RESULTS We received 1024 responses, predominantly from North America and Europe. The study revealed that while 63% of respondents were motivated to enhance the sustainability of their practice, less than 10% could accurately estimate the carbon footprint of surgical activities. Most were not concerned that sustainability efforts would negatively impact their practice and showed readiness to adopt proposed sustainable practices. Online webinars and modules were the preferred educational methods. A clustering analysis identified a group particularly concerned yet willing to adopt sustainable changes. CONCLUSION Surgeons believe that operating room waste is a critical issue and are willing to change practice to improve it. However, there exists a gap in understanding the environmental impact of surgical procedures and supplies, and a sizable minority have some degree of concern about potential adverse consequences of implementing sustainable policies. This study uniquely provides an international, multidisciplinary snapshot of surgeons' attitudes, knowledge, concerns, willingness, and preferred educational modalities related to mitigating the environmental impact of surgical practice.
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Affiliation(s)
- Tejas S Sathe
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Vittoria Bellato
- Department of Minimally Invasive Surgery, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Amir Ashraf Ganjouei
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Laleh Foroutani
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Ryan P Hall
- Department of Surgery, Tufts Medical Center, Boston, USA
| | - Oleksii Potapov
- Department of General Surgery, College of Medicine, University of Rzeszow, Rzeszow, Poland
| | - Ricardo J Bello
- Department of Surgery, Medical College of Wisconsin, Milwaukee, USA
| | - Shaneeta M Johnson
- Department of Surgery, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA.
| | - Stefania Marconi
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
- IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | - Paul Barach
- Thomas Jefferson University School of Medicine, Philadelphia, USA
- Department of General Surgery, Imperial College London, London, UK
| | | | - Sheetal Nijhawan
- Department of Surgery, Sharon Regional Medical Center, Sharon, PA, USA
| | - Wendelyn M Oslock
- Department of Surgery, University of Alabama Birmingham, Birmingham, AL, USA
- Department of Quality, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | | | - Sarah Samreen
- Division of Minimally Invasive Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Jimmy Chung
- Adventus Health Partners, Cincinnati, OH, USA
| | - Nana Marfo
- Ross University School of Medicine, Miramar, FL, USA
| | - Bright Huo
- Department of General Surgery, McMaster University, Ontario, CA, USA
| | - Robert B Lim
- Department of Surgery, Atrium Carolinas Medical Center, Wake Forest University, Charlotte, NC, USA
| | | | - Yewande R Alimi
- Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
| | | | - Alberto Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Maximos Frountzas
- First Propaedeutic Department of Surgery, Hippocration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Miran Rems
- Department of General and Abdominal Surgery, General Hospital Jesenice, Jesenice, Slovenia
| | - M M M Eussen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - N D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Patricia Sylla
- Division of Colon and Rectal Surgery, Mount Sinai Health System, New York, NY, USA
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Debnath M, Ojha S, Sharma DA, Shah S, Boora N. Role of green and sustainable practices in shaping the future of medical imaging technology: A cross-sectional multi-stakeholder analysis among students, radiographers, and academic experts. Radiography (Lond) 2024; 30:1332-1341. [PMID: 39084131 DOI: 10.1016/j.radi.2024.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION The detection and treatment of diseases like COVID, diabetes, cancer, cardiovascular conditions, etc., have made medical imaging technology more necessary, so it is expected that the demands of imaging modalities are also increasing and are major contributors to carbon emissions in the healthcare industry. Hence, the Radiology departments, like the rest of the healthcare industry should adapt the procedures to become more sustainable. METHODS A total of 1016 respondents completed the online survey to assess the perception, current practices, and challenges in adopting green and sustainable practices in medical imaging. The radio technologists, teaching faculties, and students of medical imaging were recruited for the study. The survey tool was distributed to the closed groups through social media and emails. RESULTS The majority of participants (66.6%) highlighted the importance of green and sustainable practices in medical imaging whereas only 21.06% of participants seem to have implemented these practices. Most of the participants give positive responses on the use of zero-lead aprons (77%), refurbished medical systems (85.8%), and eco-friendly packaging (89.5%). The mixed response was received from waste segregation and energy-saving measures. The majority (60.3%) of them have no formal education or training. However, they have a good attitude towards the willingness to adopt green practices. CONCLUSIONS There is a gap between perception and implementation of green and sustainable practices due to leadership and information barriers. Comprehensive training for stakeholders of medical imaging is crucial to fully integrate sustainability practices, possibly through webinars or educational modules. IMPLICATIONS FOR PRACTICE The study's findings shed light on how important medical imaging stakeholders view green and sustainable practices as well as potential obstacles to their implementation at the local level whilst suggesting the need for exclusive training on these practices to promote sustainability.
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Affiliation(s)
- M Debnath
- Department of Medical Imaging Technology, Bapubhai Desaibhai Patel Institute of Paramedical Sciences (BDIPS), Charotar University of Science and Technology, Changa, Anand, Gujarat, India.
| | - S Ojha
- Department of Medical Imaging Technology, Bapubhai Desaibhai Patel Institute of Paramedical Sciences (BDIPS), Charotar University of Science and Technology, Changa, Anand, Gujarat, India.
| | - D A Sharma
- Department of Medical Imaging Technology, Bapubhai Desaibhai Patel Institute of Paramedical Sciences (BDIPS), Charotar University of Science and Technology, Changa, Anand, Gujarat, India.
| | - S Shah
- Department of Medical Imaging Technology, Bapubhai Desaibhai Patel Institute of Paramedical Sciences (BDIPS), Charotar University of Science and Technology, Changa, Anand, Gujarat, India.
| | - N Boora
- Radio-Imaging Department, College of Paramedical Sciences, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India.
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Drouaud AP, Miller PE, O'Byrne JM. The environmental impact of hip and knee arthroplasty: An analysis of carbon emissions and disposal costs. Surgeon 2024; 22:221-226. [PMID: 38724298 DOI: 10.1016/j.surge.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 08/11/2024]
Abstract
BACKGROUND AND PURPOSE The rise in hip and knee arthroplasty for osteoarthritis requires addressing healthcare system pollution to support Ireland's climate change goals. This research aimed to quantify waste generated and determine environmental and economic impacts to promote sustainable strategies in joint arthroplasty and shed light on the suboptimal waste management practices. METHODS The study was conducted at National Orthopaedic Hospital Cappagh (NOHC), measuring waste generated during hip and knee arthroplasty. Clinical, domestic, and recycled waste weights were recorded, including the segregation of Central Sterile Supply Department (CSSD) Blue Wrap waste in ten operations. Kilograms of carbon dioxide emissions (kgCO2e) and disposal costs were calculated. RESULTS In a sample of 100 joint arthroplasty operations, the study found that revision knees produced 23.58 kgCO2e per case, revision hips 23.50 kgCO2e, primary knees 15.82 kgCO2e, and primary hips 14.64 kgCO2e. CSSD Blue Wrap contributed on average 13.5% of OT waste. Extrapolating these findings to the estimated number of joint arthroplasties performed in 2022 at NOHC (1556 hip and knee joint arthroplasties), the emissions were estimated to be 24,576 kgCO2e, with the cost of disposal up to €29,228. Strategies to mitigate this waste have been identified and proposed. CONCLUSION The research aimed to address the environmental impact of orthopaedic joint arthroplasties, offering strategies to reduce waste generation, carbon emissions, and cost. Utilising our methodology to calculate greenhouse gas emissions will empower sustainability offices to conduct their own waste audits and implementing our strategies for waste management practices can help minimise environmental waste.
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Affiliation(s)
- Arthur P Drouaud
- The George Washington University School of Medicine and Health Sciences, 2300 I St., NW, Washington, D.C., 20037, USA.
| | - Peggy E Miller
- National Orthopaedic Hospital Cappagh, Cappagh Rd, Finglas, Dublin 11, Ireland.
| | - John M O'Byrne
- National Orthopaedic Hospital Cappagh, Cappagh Rd, Finglas, Dublin 11, Ireland; Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
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Mohr-Sasson A, Aycock M, Higgason N, Hui M, Bhalwal A, Jalloul R, Leon MG, Dziadek O, Montealegre A. Excess use of surgical supplies in minimally invasive benign gynecology surgery: an observational study. Am J Obstet Gynecol 2024; 231:273.e1-273.e7. [PMID: 38761838 DOI: 10.1016/j.ajog.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/13/2024] [Accepted: 05/11/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Single-use materials and equipment are regularly opened by the surgical team during procedures but left unused, potentially resulting in superfluous costs and excess environmental waste. OBJECTIVE This study aimed to estimate the excess use of surgical supplies in minimally invasive benign gynecologic surgeries. STUDY DESIGN This is a prospective observational study conducted at a university-affiliated single tertiary medical center. Designated study personnel were assigned to observe surgical procedures performed during July to September 2022. Surgical teams were observed while performing surgeries for benign indications. The teams were not informed of the purpose of the observation to avoid potential bias. Disposable materials and equipment opened during the procedure were documented. Excess supplies were defined as those opened but left unused before being discarded. Costs per item of the excess supplies were estimated on the basis of material and equipment costs provided by the hospital. RESULTS A total of 99 surgeries were observed, including laparoscopic (32%), robotic (39%), hysteroscopic (14%), vaginal (11%), and laparotomy procedures (3%). Excess use of surgical supplies was documented in all but one procedure. The total cost across all surgeries reached $6357. The contained tissue extraction bag was the most expensive item not used (Applied Medical, Rancho Santa Margarita, CA; $390 per unit) in 4 procedures, contributing 25.54% to the total cost. Raytec was the most common surgical waste, with a total of n=583 opened but unused (average n=5.95 per surgery). A significant difference was found in the rate of excess supplies across the surgical approaches, with robotic surgery contributing 52.19% of the total cost (P=.01). CONCLUSION Excess use of disposable materials and equipment is common in minimally invasive benign gynecologic surgeries and contributes to superfluous costs and excess environmental waste. It is predominantly attributed to the opening of inexpensive materials that are left unused during the procedure. Increased awareness of costs and generated waste may reduce excess use of surgical supplies and should be further explored in future research.
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Affiliation(s)
- Aya Mohr-Sasson
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Madison Aycock
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Noel Higgason
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Mason Hui
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Asha Bhalwal
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Randa Jalloul
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Mateo G Leon
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Olivia Dziadek
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Alvaro Montealegre
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
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Filiberto AC, Loftus TJ, Crippen CJ, Hu D, Balch JA, Efron PA, Sarosi GA, Upchurch GR. Operating Room Supply Cost and Value of Care after Implementing a Sustainable Quality Intervention. J Am Coll Surg 2024; 238:404-413. [PMID: 38224109 DOI: 10.1097/xcs.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
BACKGROUND Variability in operating room supply cost is a modifiable cause of suboptimal resource use and low value of care (outcomes vs cost). This study describes implementation of a quality improvement intervention to decrease operating room supply costs. STUDY DESIGN An automated electronic health record data pipeline harmonized operating room supply cost data with patient and case characteristics and outcomes. For inpatient procedures, predicted mortality and length of stay were used to calculate observed-to-expected ratios and value of care using validated equations. For commonly performed (1 or more per week) procedures, the pipeline generated figures illustrating individual surgeon performance vs peers, costs for each surgeon performing each case type, and control charts identifying out-of-control cases and surgeons with more than 90th percentile costs, which were shared with surgeons and division chiefs alongside guidance for modifying case-specific supply instructions to operating room nurses and technicians. RESULTS Preintervention control (1,064 cases for 7 months) and postintervention (307 cases for 2 months) cohorts had similar baseline characteristics across all 16 commonly performed procedures. Median costs per case were lower in the intervention cohort ($811 [$525 to $1,367] vs controls: $1,080 [$603 to $1,574], p < 0.001), as was the incidence of out-of-control cases (19 (6.2%) vs 110 (10.3%), p = 0.03). Duration of surgery, length of stay, discharge disposition, and 30-day mortality and readmission rates were similar between cohorts. Value of care was higher in the intervention cohort (1.1 [0.1 to 1.5] vs 1.0 [0.2 to 1.4], p = 0.04). Pipeline runtime was 16:07. CONCLUSIONS An automated, sustainable quality improvement intervention was associated with decreased operating room supply costs and increased value of care.
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Affiliation(s)
- Amanda C Filiberto
- From the Department of Surgery, University of Florida Health, Gainesville, FL (Filiberto, Loftus, Crippen, Balch, Efron, Sarosi, Upchurch)
| | - Tyler J Loftus
- From the Department of Surgery, University of Florida Health, Gainesville, FL (Filiberto, Loftus, Crippen, Balch, Efron, Sarosi, Upchurch)
- Intelligent Critical Care Center (IC3), University of Florida, Gainesville, FL (Loftus, Hu)
| | - Cristina J Crippen
- From the Department of Surgery, University of Florida Health, Gainesville, FL (Filiberto, Loftus, Crippen, Balch, Efron, Sarosi, Upchurch)
| | - Die Hu
- Intelligent Critical Care Center (IC3), University of Florida, Gainesville, FL (Loftus, Hu)
| | - Jeremy A Balch
- From the Department of Surgery, University of Florida Health, Gainesville, FL (Filiberto, Loftus, Crippen, Balch, Efron, Sarosi, Upchurch)
| | - Philip A Efron
- From the Department of Surgery, University of Florida Health, Gainesville, FL (Filiberto, Loftus, Crippen, Balch, Efron, Sarosi, Upchurch)
| | - George A Sarosi
- From the Department of Surgery, University of Florida Health, Gainesville, FL (Filiberto, Loftus, Crippen, Balch, Efron, Sarosi, Upchurch)
| | - Gilbert R Upchurch
- From the Department of Surgery, University of Florida Health, Gainesville, FL (Filiberto, Loftus, Crippen, Balch, Efron, Sarosi, Upchurch)
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Almukhtar A, Batcup C, Bowman M, Winter-Beatty J, Leff D, Demirel P, Porat T, Judah G. Barriers and facilitators to sustainable operating theatres: a systematic review using the Theoretical Domains Framework. Int J Surg 2024; 110:554-568. [PMID: 37889570 PMCID: PMC10793789 DOI: 10.1097/js9.0000000000000829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The health sector contributes significantly to the climate crisis. Operating theatres (OTs) in particular are a major contributor of greenhouse gas emissions and waste, and while there are several evidence-based guidelines to reduce this impact, these are often not followed. The authors systematically reviewed the literature to identify barriers and facilitators of sustainable behaviour in OTs, categorising these using the Theoretical Domains Framework (TDF). MATERIALS AND METHODS Medline, Embase, PsychInfo, and Global Health databases were searched for articles published between January 2000 and June 2023, using the concepts: barriers and facilitators, sustainability, and surgery. Two reviewers screened abstracts from identified studies, evaluated quality, and extracted data. Identified determinants were mapped to TDF domains and further themes as required. The results were reported in line with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and AMSTAR (A MeaSurement Tool to Assess Systematic Reviews) guidelines. RESULTS Twenty-one studies were selected for analysis and assessment (17 surveys and four interview studies) comprising 8286 participants, including surgeons, nurses, and anaesthetists. Eighteen themes across 10 TDF domains were identified. The most common barriers to adoption of green behaviours in OTs were in domains of: 'knowledge' ( N =18), for example knowledge of sustainable practices; 'environmental context and resources' ( N =16) for example personnel shortage and workload and inadequate recycling facilities; 'social influences' ( N =9) for example lack of leadership/organisational mandate or support; 'beliefs about consequences' ( N =9) for example concerns regarding safety. Intention was the most common facilitator, with 11 studies citing it. CONCLUSIONS Despite intentions to adopt sustainable practices in OTs, this review identified several barriers to doing so. Interventions should focus on mitigating these, especially by improving staff's knowledge of sustainability practices and working within the environmental context and time pressures. Furthermore, institutional change programmes and policies are needed to prioritise sustainability at the hospital and trust level. Additional qualitative work should also be conducted using behavioural frameworks, to more comprehensively investigate barriers and determinants to decarbonise OTs.
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Affiliation(s)
- Aws Almukhtar
- Department of General Surgery, Imperial College Healthcare NHS Trust
- Department of Surgery and Cancer, St Mary’s Hospital
| | - Carys Batcup
- Dyson School of Design Engineering, Imperial College London
| | - Miranda Bowman
- Department of Breast Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | | | - Daniel Leff
- Department of Surgery and Cancer, St Mary’s Hospital
- Department of Breast Surgery, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Pelin Demirel
- Dyson School of Design Engineering, Imperial College London
| | - Talya Porat
- Dyson School of Design Engineering, Imperial College London
| | - Gaby Judah
- Department of Surgery and Cancer, St Mary’s Hospital
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Petit HJ, Sullivan GA, Hughes IM, Pittman KL, Myers JA, Cocoma SM, Gulack BC, Shah AN. Exploring Barriers and Facilitators to Reducing the Environmental Impact of the Operating Room. J Surg Res 2023; 292:197-205. [PMID: 37639946 DOI: 10.1016/j.jss.2023.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 07/19/2023] [Accepted: 07/23/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION The operating room (OR) is a major contributor to greenhouse gas emissions both nationally and globally. Successful implementation of quality improvement initiatives requires understanding of key stakeholders' perspectives of the issues at hand. Our aim was to explore surgical, anesthesia, and OR staff member perspectives on barriers and facilitators to reducing OR waste. MATERIALS AND METHODS Identified stakeholders from a single academic medical center were interviewed to identify important barriers and facilitators to reducing surgical waste. Two team members with qualitative research experience used deductive logic guided by the Theoretical Domains Framework of behavior change to identify themes within transcripts. RESULTS Nineteen participants including surgeons (n = 3, 15.8%), surgical residents (n = 5, 26.3%), an anesthesiologist (n = 1, 5.3%), anesthesia residents (n = 2, 10.5%), nurse anesthetists (n = 2, 10.5%), nurses (n = 5, 26.3%), and a surgical technologist (n = 1, 5.3%) were interviewed. Twelve of the 14 themes within the Theoretical Domains Framework were discovered in transcripts. Barriers within these themes included lack of resources to pursue environmental sustainability in the OR and the necessity of maintaining sterility for patient safety. Facilitators included emphasizing surgeon leadership within the OR to reduce unused supplies and spreading awareness of the environmental and economic impact of surgical waste. CONCLUSIONS Interviewed stakeholders were able to identify areas where improvements around surgical waste reduction and management could be made at the institution by describing barriers and facilitators to sustainability-driven interventions. Future surgical waste reduction initiatives at this institution will be guided by these important perspectives.
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Affiliation(s)
- Hayley J Petit
- Rush Medical College, Rush University Medical Center, Chicago, Illinois
| | - Gwyneth A Sullivan
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Ian M Hughes
- Environmental Sustainability, Rush University Medical Center, Chicago, Illinois
| | - Katie L Pittman
- Environmental Sustainability, Rush University Medical Center, Chicago, Illinois
| | - Jonathan A Myers
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Sarah M Cocoma
- Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois
| | - Brian C Gulack
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Ami N Shah
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois.
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11
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Dixon W, Ndovu A, Faust M, Sathe T, Boscardin C, Roll GR, Wang K, Gandhi S. Cost Saving in the Operating Room: Scoping Review of Surgical Scorecards. J Am Coll Surg 2023; 237:912-922. [PMID: 37787413 DOI: 10.1097/xcs.0000000000000846] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Affiliation(s)
- Wesley Dixon
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (Dixon)
| | - Allan Ndovu
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (Dixon)
| | - Millis Faust
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (Dixon)
| | - Tejas Sathe
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (Dixon)
| | - Christy Boscardin
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (Dixon)
| | - Garrett R Roll
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (Dixon)
| | - Kaiyi Wang
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (Dixon)
| | - Seema Gandhi
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (Dixon)
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12
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Sullivan GA, Reiter AJ, Smith C, Glick RD, Skarda DE, Le HD, Gow KW, Rich BS, Raval MV. Pediatric Surgeon Perceptions on Operating Room Environmental Stewardship and Current Institutional Climate-Smart Actions. J Pediatr Surg 2023; 58:2278-2285. [PMID: 37468347 DOI: 10.1016/j.jpedsurg.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Operating rooms generate significant greenhouse gas emissions. Our objective was to assess current institutional climate-smart actions and pediatric surgeon perceptions regarding environmental stewardship efforts in the operating room. METHODS A survey was distributed to members of the American Pediatric Surgical Association in June 2022. The survey was piloted among ten general surgery residents and two professional society cohorts of pediatric surgeons. Comparisons were made by demographic and practice characteristics. RESULTS Survey response rate was 15.9% (n = 160/1009) and included surgeons predominantly from urban (n = 93/122, 76.2%) and academic (n = 84/122, 68.9%) institutions. Only 9.8% (n = 12/122) of pediatric surgeons were currently involved in operating room environmental initiatives. The most common climate-smart actions were reusable materials and equipment (n = 120/159, 75.5%) and reprocessing of medical devices (n = 111/160, 69.4%). Most surgeons either strongly agreed (n = 48/121, 39.7%) or agreed (n = 62/121, 51.2%) that incorporation of environmental stewardship practices at work was important. Surgeons identified reusable materials/equipment (extremely important: n = 61/129, 47.3%, important: n = 38/129, 29.5%) and recycling (extremely important: n = 68/129, 52.7%, important: n = 29/129, 22.5%) as the most important climate-smart actions. Commonly perceived barriers were financial (extremely likely: n = 47/123, 38.2%, likely: n = 50/123, 40.7%) and staff resistance to change (extremely likely: n = 29/123, 23.6%, likely: n = 60/123, 48.8%). Regional differences included low adoption of energy efficiency strategies among respondents from southern states (n = 0/26, p = 0.01) despite high perceived importance relative to other regions (median: 5, IQR: 4-5 vs median: 4, IQR 4-5, p = 0.04). CONCLUSIONS While most pediatric surgeons agreed that environmental stewardship was important, less than 10% are currently involved in initiatives at their institutions. Opportunities exist for surgical leadership surrounding implementation of climate-smart actions. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Gwyneth A Sullivan
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Audra J Reiter
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Charesa Smith
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Richard D Glick
- Division of Pediatric Surgery, Department of Surgery, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - David E Skarda
- University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT, USA; Primary Children's Hospital, Intermountain Health Care, Salt Lake City, UT, USA
| | - Hau D Le
- Division of Pediatric Surgery, Department of Surgery, American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kenneth W Gow
- Seattle Children's Hospital and the University of Washington, Seattle, WA, USA
| | - Barrie S Rich
- Division of Pediatric Surgery, Department of Surgery, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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13
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Sullivan GA, Reiter AJ, Hu A, Smith C, Storton K, Gulack BC, Shah AN, Dsida R, Raval MV. Operating Room Recycling: Opportunities to Reduce Carbon Emissions Without Increases in Cost. J Pediatr Surg 2023; 58:2187-2191. [PMID: 37188613 DOI: 10.1016/j.jpedsurg.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/10/2023] [Accepted: 04/16/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND The healthcare industry is a major contributor to greenhouse gas emissions. Within the hospital, operating rooms are responsible for the largest proportion of emissions due to high resource utilization and waste generation. Our aim was to generate estimates of greenhouse gas emissions avoided and cost implications following implementation of a recycling program across operating rooms at our freestanding children's hospital. METHODS Data were collected from three commonly performed pediatric surgical procedures: circumcision, laparoscopic inguinal hernia repair, and laparoscopic gastrostomy tube placement. Five cases of each procedure were observed. Recyclable paper and plastic waste was weighed. Emission equivalencies were determined using the Environmental Protection Agency Greenhouse Gas Equivalencies Calculator. Institutional cost of waste disposal was $66.25 United States Dollars (USD)/ton for recyclable waste and $67.00 USD/ton for solid waste. RESULTS The proportion of recyclable waste ranged from 23.3% for circumcision to 29.5% for laparoscopic gastrostomy tube placement. The amount of waste redirected from landfill to a recycling stream could result in annual avoidance of 58,500 to 91,500 kg carbon dioxide equivalent emissions, or 6583 to 10,296 gallons of gasoline. Establishing a recycling program would not require additional cost and could lead to modest cost savings (range $15 to 24 USD/year). CONCLUSIONS Incorporation of recycling into operating rooms has the potential to reduce greenhouse gas emissions without increased cost. Clinicians and hospital administrators should consider operating room recycling programs as they work towards improved environmental stewardship. LEVEL OF EVIDENCE Level VI - evidence form a single descriptive or qualitative study.
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Affiliation(s)
- Gwyneth A Sullivan
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Audra J Reiter
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Andrew Hu
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Charesa Smith
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Katelyn Storton
- Supply Chain and Strategic Sourcing Operations, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Brian C Gulack
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Ami N Shah
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Richard Dsida
- Department of Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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14
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Kornberg Z, Wu J, Wilmot H, Duffina T, Shah JB. A Leak in the System: Addressing the Environmental Impact of Urologic Care. Eur Urol 2023; 84:260-262. [PMID: 37225526 DOI: 10.1016/j.eururo.2023.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/27/2023] [Indexed: 05/26/2023]
Abstract
As urologists we have an opportunity to reduce the carbon footprint of the procedures we perform. We highlight some areas of interest in urology and potential initiatives to reduce the energy and waste footprint of urology care. Urologists can and should make an impact on the growing climate crisis.
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Affiliation(s)
| | - Jaclyn Wu
- Department of General Surgery, Stanford University, Stanford, CA, USA
| | - Helen Wilmot
- General Services and Space Planning, Stanford University, Stanford, CA, USA
| | - Terry Duffina
- Sustainability Program Office, Stanford University, Stanford, CA, USA
| | - Jay B Shah
- Department of Urology, Stanford University, Stanford, CA, USA.
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15
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Goldfield NM, Malapati P, Chafitz T, Saravanapavan Y, Alamgir N, Gander J, Meyer MJ. Sterile surgical supply waste identification using asynchronous analysis: Pediatric surgery QI pilot. Surg Open Sci 2023; 15:32-37. [PMID: 37609369 PMCID: PMC10440549 DOI: 10.1016/j.sopen.2023.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 08/24/2023] Open
Abstract
Background The operating room (OR) is a major cost and revenue center for a hospital. One of the few modifiable costs in the OR is single-use, sterile surgical supplies (SUSSS). If SUSSS are opened on the scrub table and not used, then they are wasted. High-fidelity SUSSS usage data is important to strategically implement solutions to reduce waste of SUSSS in the OR. OR waste reduction may decrease health systems' carbon footprints and reduce spending. Methods A convenience sample of general pediatric surgical cases was observed in summer 2021. HIPAA-free images of the surgical scrub table were acquired every 2 s with minimal impact on pediatric OR workflow. These images were asynchronously analyzed to obtain SUSSS usage data for each case. Results Image data from three pediatric surgeons performing 41 pediatric surgeries was reviewed. The median cost of unused SUSSS was $13.10 (IQR = $2.73-$47.97) with a range of $0.07 to $489.08 wasted in a single surgery. The mean number of items wasted was 9.3 ± 6.4. The most frequently wasted items were sutures, syringes, towels, paper rulers, and specimen cups. The most expensive sources of waste were laparoscopic trocars, sutures, insufflation needles, drapes, and guidewires. Conclusions SUSSS that were discarded without being used were successfully identified through the asynchronous analysis of HIPAA-free OR scrub table image data. This may be an opportunity to identify SUSSS waste efficiently without an observer in the OR.
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Affiliation(s)
- Natalie M. Goldfield
- University of Virginia School of Medicine, 1340 Jefferson Park Ave, Charlottesville, VA, USA
| | | | - Tyler Chafitz
- Mount Sinai Health System, 1 Gustave L. Levy Pl, New York, NY, USA
| | | | - Nafisa Alamgir
- Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, USA
| | - Jeffrey Gander
- University of Virginia School of Medicine, 1340 Jefferson Park Ave, Charlottesville, VA, USA
| | - Matthew J. Meyer
- University of Virginia School of Medicine, 1340 Jefferson Park Ave, Charlottesville, VA, USA
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16
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Lakatos K, Teherani A, Thottathil SE, Gandhi S, Weiser SD, Brindis CD. A race to net zero-early lessons from healthcare's decarbonization marathon. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad006. [PMID: 38770407 PMCID: PMC11103727 DOI: 10.1093/haschl/qxad006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/16/2023] [Indexed: 05/22/2024]
Abstract
Climate change poses a threat to healthcare systems; at the same time, healthcare systems contribute to a worsening climate. Climate-induced disasters are predicted to increase both the demand for healthcare services while also posing a threat to the integrity of healthcare systems' infrastructures and supply chains. Many healthcare organizations have taken initiatives to prepare for such disasters through implementing carbon emission-reduction practices and infrastructure reinforcement, through globally recognized frameworks and strategies known as Scopes 1, 2, and 3, and decarbonization. We explored the efforts of these early adopters to understand how they are thinking about and addressing climate change's impacts on healthcare. Through a process of reviewing the peer-reviewed literature, publicly available published documents, annual sustainability reports, conference presentations, and participation in a national decarbonization collaborative, we (1) provide a diverse set of examples showcasing the variety of ways healthcare systems are responding; (2) identify a set of emergent key themes to implementing decarbonization practices, such as the role of an organizational culture of iterative improvement and building systems of cross-organizational collaboration; and (3) synthesize the identifiable set of driving factors for long-term sustainability of these decarbonization efforts.
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Affiliation(s)
- Kyle Lakatos
- School of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
- Harvard Kennedy School of Government, Cambridge, MA 02138, United States
| | - Arianne Teherani
- School of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
- UC Center for Climate, Health, and Equity, University of California, CA, United States
| | - Sapna E Thottathil
- UC Center for Climate, Health, and Equity, University of California, CA, United States
| | - Seema Gandhi
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA 94143, United States
- University of California, San Francisco, San Francisco, CA 94143, United States
| | - Sheri D Weiser
- School of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
- UC Center for Climate, Health, and Equity, University of California, CA, United States
| | - Claire D Brindis
- UC Center for Climate, Health, and Equity, University of California, CA, United States
- University of California, San Francisco, San Francisco, CA 94143, United States
- Philip R. Lee Institute for Health Policy Studies, San Francisco, CA 94158, United States
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17
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Davies JF, Ikin B, Francis JJ, McGain F. Implementation approaches to improve environmental sustainability in operating theatres: a systematic review. Br J Anaesth 2023:S0007-0912(23)00253-2. [PMID: 37344341 DOI: 10.1016/j.bja.2023.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023] Open
Abstract
Operating theatres consume large amounts of energy and consumables and produce large amounts of waste. There is an increasing evidence base for reducing the climate impacts of healthcare that could be enacted into routine practice; yet, healthcare-associated emissions increase annually. Implementation science aims to improve the systematic uptake of evidence-based care into practice and could, therefore, assist in addressing the environmental impacts of healthcare. The aim of this systematic search with narrative synthesis was to explore what implementation approaches have been applied to reduce the environmental impact of operating theatre activities, described by implementation phases and methodologies. A search was conducted in EMBASE, PubMed, and CINAHL, limited to English and publication since 2010. In total, 3886 articles were retrieved and 11 were included. All were in the exploratory phase (seven of 11) or initial implementation phase (four of 11), but none were in the installation or full implementation phase. Three studies utilised a recognised implementation theory, model, or framework in the design. Four studies used interprofessional education to influence individuals' behaviour to reduce waste, improve waste segregation, or reduce anaesthetic gases. Of those that utilised behaviour change interventions, all were qualitatively successful in achieving environmental improvement. There was an absence of evidence for sustained effects in the intervention studies and little follow-up from studies that explored barriers to innovation. This review demonstrates a gap between evidence for reducing environmental impacts and uptake of proposed practice changes to deliver low-carbon healthcare. Future research into 'greening' healthcare should use implementation research methods to establish a solid implementation evidence base. SYSTEMATIC REVIEW PROTOCOL: PROSPERO CRD42022342786.
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Affiliation(s)
- Jessica F Davies
- Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
| | - Brigit Ikin
- Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia
| | - Jillian J Francis
- School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia; Centre for Implementation Research, Ottawa Hospital Research Institute-General Campus, Ottawa, ON, Canada
| | - Forbes McGain
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia, Western Health, Footscray, Victoria, Australia; Department of Intensive Care, Western Health, Footscray, Victoria, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
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18
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Sullivan GA, Petit HJ, Reiter AJ, Westrick JC, Hu A, Dunn JB, Gulack BC, Shah AN, Dsida R, Raval MV. Environmental Impact and Cost Savings of Operating Room Quality Improvement Initiatives: A Scoping Review. J Am Coll Surg 2023; 236:411-423. [PMID: 36648269 DOI: 10.1097/xcs.0000000000000478] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Operating rooms are major contributors to a hospital's carbon footprint due to the large volumes of resources consumed and waste produced. The objective of this study was to identify quality improvement initiatives that aimed to reduce the environmental impact of the operating room while decreasing costs. STUDY DESIGN A literature search was performed using PubMed, Scopus, CINAHL, and Google Scholar and included broad terms for "operating room," "costs," and "environment" or "sustainability." The "triple bottom line" framework, which considers the environmental, financial, and social impacts of interventions to guide decision making, was used to inform data extraction. The studies were then categorized using the 5 "Rs" of sustainability-refuse, reduce, reuse, repurpose, and recycle-and the impacts were discussed using the triple bottom line framework. RESULTS A total of 23 unique quality improvement initiatives describing 28 interventions were included. Interventions were categorized as "refuse" (n = 11; 39.3%), "reduce" (n = 8; 28.6%), "reuse" (n = 3; 10.7%), and "recycle" (n = 6; 21.4%). While methods of measuring environmental impact and cost savings varied greatly among studies, potential annual cost savings ranged from $873 (intervention: education on diverting recyclable materials from sharps containers; environmental impact: 11.4 kg sharps waste diverted per month) to $694,141 (intervention: education to reduce regulated medical waste; environmental impact: 30% reduction in regulated medical waste). CONCLUSIONS Quality improvement initiatives that reduce both cost and environmental impact have been successfully implemented across a variety of centers both nationally and globally. Surgeons, healthcare practitioners, and administrators interested in environmental stewardship and working toward a culture of sustainability may consider similar interventions in their institutions.
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Affiliation(s)
- Gwyneth A Sullivan
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
| | - Hayley J Petit
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
| | - Audra J Reiter
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
| | - Jennifer C Westrick
- the Library of Rush Medical Center (Westrick), Rush University Medical Center, Chicago, IL
| | - Andrew Hu
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
| | - Jennifer B Dunn
- the Chemical and Biological Engineering, Northwestern University, Evanston, IL (Dunn)
| | - Brian C Gulack
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
- the Department of Anesthesiology (Dsida), Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
- the Library of Rush Medical Center (Westrick), Rush University Medical Center, Chicago, IL
- the Chemical and Biological Engineering, Northwestern University, Evanston, IL (Dunn)
| | - Ami N Shah
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
- the Department of Anesthesiology (Dsida), Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
- the Library of Rush Medical Center (Westrick), Rush University Medical Center, Chicago, IL
- the Chemical and Biological Engineering, Northwestern University, Evanston, IL (Dunn)
| | - Richard Dsida
- the Department of Anesthesiology (Dsida), Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
| | - Mehul V Raval
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
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19
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Hathi K, Fowler J, Zahabi S, Dzioba A, Madou E, Gunz AC, Sowerby LJ, Nichols AC, Strychowsky JE. Attitudes and Perceptions of Canadian Otolaryngology‐Head and Neck Surgeons and Residents on Environmental Sustainability. OTO Open 2023; 7:e40. [PMID: 36998559 PMCID: PMC10046710 DOI: 10.1002/oto2.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/21/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Healthcare systems, specifically operating rooms, significantly contribute to greenhouse gas emissions. Addressing operating room environmental sustainability requires understanding current practices, opinions, and barriers. This is the first study assessing the attitudes and perceptions of otolaryngologists on environmental sustainability. Study Design Cross-sectional virtual survey. Setting Email survey to active members of the Canadian Society of Otolaryngology-Head and Neck Surgery. Methods A 23-question survey was developed in REDCap. The questions focused on four themes: (1) demographics, (2) attitudes and beliefs, (3) institutional practices, and (4) education. A combination of multiple choice, Likert-scale, and open-ended questions were employed. Results Response rate was 11% (n = 80/699). Most respondents strongly believed in climate change (86%). Only 20% strongly agree that operating rooms contribute to the climate crisis. Most agree environmental sustainability is very important at home (62%) and in their community (64%), only 46% said it was very important in the operating room. Barriers to environmental sustainability were incentives (68%), hospital supports (60%), information/knowledge (59%), cost (58%), and time (50%). Of those involved in residency programs, 89% (n = 49/55) reported there was no education on environmental sustainability or they were unsure if there was. Conclusion Canadian otolaryngologists strongly believe in climate change, but there is more ambivalence regarding operating rooms as a significant contributor. There is a need for further education and a systemic reduction of barriers to facilitate eco-action in otolaryngology operating rooms.
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Affiliation(s)
- Kalpesh Hathi
- Faculty of Medicine Dalhousie Medicine New Brunswick Saint John New Brunswick Canada
| | - James Fowler
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Sarah Zahabi
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Agnieszka Dzioba
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Edward Madou
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Anna C. Gunz
- Department of Paediatrics Western University Ontario London Canada
| | - Leigh J. Sowerby
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Anthony C. Nichols
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Julie E. Strychowsky
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
- Department of Paediatrics Western University Ontario London Canada
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20
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Shum PL, Kok HK, Maingard J, Zhou K, Van Damme V, Barras CD, Slater LA, Chong W, Chandra RV, Jhamb A, Brooks M, Asadi H. Sustainability in interventional radiology: are we doing enough to save the environment? CVIR Endovasc 2022; 5:60. [PMCID: PMC9703417 DOI: 10.1186/s42155-022-00336-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/31/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Healthcare waste contributes substantially to the world’s carbon footprint. Our aims are to review the current knowledge of Interventional Radiology (IR) waste generation and ways of reducing waste in practice, to quantify the environmental and financial impact of waste generated and address green initiatives to improve IR waste management.
Methods
A systematic literature search was conducted in July 2022 using the Medline and Embase literature databases. The scope of the search included the field of IR as well as operating theatre literature, where relevant to IR practice.
Results
One-hundred articles were reviewed and 68 studies met the inclusion criteria. Greening initiatives include reducing, reusing and recycling waste, as well as strict waste segregation. Interventional radiologists can engage with suppliers to reformulate procedure packs to minimize unnecessary items and packaging. Opened but unused equipment can be prevented if there is better communication within the team and increased staff awareness of wasted equipment cost. Incentives to use soon-to-expire equipment can be offered. Power consumption can be reduced by powering down operating room lights and workstations when not in use, changing to Light Emitting Diode (LED) and motion sensor lightings. Surgical hand wash can be replaced with alcohol-based hand rubs to reduce water usage. Common barriers to improving waste management include the lack of leadership, misconceptions regarding infectious risk, lack of data, concerns about increased workload, negative staff attitudes and resistance to change. Education remains a top priority to engage all staff in sustainable healthcare practices.
Conclusion
Interventional radiologists have a crucial role to play in improving healthcare sustainability. By implementing small, iterative changes to our practice, financial savings, greater efficiency and improved environmental sustainability can be achieved.
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Schwartz KM, Wright KN, Richards EG, King LP, Park AJ. Sustainability in Health Care: A Call to Action for Surgeons and Health Care Leaders. J Minim Invasive Gynecol 2022; 29:1040-1042. [PMID: 35788396 DOI: 10.1016/j.jmig.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Kaia M Schwartz
- OB/GYN & Women's Health Institute, Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Kelly N Wright
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Elliott G Richards
- OB/GYN & Women's Health Institute, Division of Reproductive Endocrinology and Infertility, Cleveland Clinic, Cleveland, Ohio
| | - Louise Perkins King
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Amy J Park
- OB/GYN & Women's Health Institute, Division of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio.
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