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Slutzman JE, Bockius H, Gordon IO, Greene HC, Hsu S, Huang Y, Lam MH, Roberts T, Thiel CL. Waste audits in healthcare: A systematic review and description of best practices. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2023; 41:3-17. [PMID: 35652693 PMCID: PMC9925917 DOI: 10.1177/0734242x221101531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/30/2022] [Indexed: 06/15/2023]
Abstract
Healthcare generates large amounts of waste, harming both environmental and human health. Waste audits are the standard method for measuring and characterizing waste. This is a systematic review of healthcare waste audits, describing their methods and informing more standardized auditing and reporting. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE, Embase, Inspec, Scopus and Web of Science Core Collection databases for published studies involving direct measurement of waste in medical facilities. We screened 2398 studies, identifying 156 studies for inclusion from 37 countries. Most were conducted to improve local waste sorting policies or practices, with fewer to inform policy development, increase waste diversion or reduce costs. Measurement was quantified mostly by weighing waste, with many also counting items or using interviews or surveys to compile data. Studies spanned single procedures, departments and hospitals, and multiple hospitals or health systems. Waste categories varied, with most including municipal solid waste or biohazardous waste, and others including sharps, recycling and other wastes. There were significant differences in methods and results between high- and low-income countries. The number of healthcare waste audits published has been increasing, with variable quality and general methodologic inconsistency. A greater emphasis on consistent performance and reporting standards would improve the quality, comparability and usefulness of healthcare waste audits.
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Affiliation(s)
- Jonathan E Slutzman
- Center for the Environment and
Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Emergency Medicine,
Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA
| | - Hannah Bockius
- Department of Biomedical
Engineering, University of Delaware, Newark, DE, USA
| | - Ilyssa O Gordon
- Robert J. Tomsich Pathology &
Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic,
Cleveland, OH, USA
| | - Hannah C Greene
- Department of Biology, New York
University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Sarah Hsu
- Warren Alpert Medical School,
Brown University, Providence, RI, USA
| | | | - Michelle H Lam
- Department of Chemical and
Biomolecular Engineering, NYU Tandon School of Engineering, Brooklyn, NY,
USA
| | - Timothy Roberts
- Health Sciences Library, NYU
Langone Health, Grossman School of Medicine, New York University, New York,
NY, USA
| | - Cassandra L Thiel
- Grossman School of Medicine,
Wagner Graduate School of Public Service, Tandon School of Engineering, New
York University, New York, NY, USA
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Red Blood Cell Transfusion in the Emergency Department: An Observational Cross-Sectional Multicenter Study. J Clin Med 2021; 10:jcm10112475. [PMID: 34199655 PMCID: PMC8199757 DOI: 10.3390/jcm10112475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background: We aimed to describe red blood cell (RBC) transfusions in the emergency department (ED) with a particular focus on the hemoglobin (Hb) level thresholds that are used in this setting. Methods: This was a cross-sectional study of 12 EDs including all adult patients that received RBC transfusion in January and February 2018. Descriptive statistics were reported. Logistic regression was performed to assess variables that were independently associated with a pre-transfusion Hb level ≥ 8 g/dL. Results: During the study period, 529 patients received RBC transfusion. The median age was 74 (59–85) years. The patients had a history of cancer or hematological disease in 185 (35.2%) cases. Acute bleeding was observed in the ED for 242 (44.7%) patients, among which 145 (59.9%) were gastrointestinal. Anemia was chronic in 191 (40.2%) cases, mostly due to vitamin or iron deficiency or to malignancy with transfusion support. Pre-transfusion Hb level was 6.9 (6.0–7.8) g/dL. The transfusion motive was not notified in the medical chart in 206 (38.9%) cases. In the multivariable logistic regression, variables that were associated with a higher pre-transfusion Hb level (≥8 g/dL) were a history of coronary artery disease (OR: 2.09; 95% CI: 1.29–3.41), the presence of acute bleeding (OR: 2.44; 95% CI: 1.53–3.94), and older age (OR: 1.02/year; 95% CI: 1.01–1.04). Conclusion: RBC transfusion in the ED was an everyday concern and involved patients with heterogeneous medical situations and severity. Pre-transfusion Hb level was rather restrictive. Almost half of transfusions were provided because of acute bleeding which was associated with a higher Hb threshold.
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Blood component utilization before and after implementation of good transfusion practice measures in a pediatric emergency department. Transfus Apher Sci 2020; 59:102719. [PMID: 31953106 DOI: 10.1016/j.transci.2020.102719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We aimed to determine the pattern of blood component utilization in pediatric Emergency Department (ED) and compare the utilization rate before and after the implementation of simple good transfusion practice measures. MATERIAL AND METHODS This was a prospective pre/post interventional study conducted between February 2015 and April 2016. The study included 3 phases [1] Pre-intervention phase (6 weeks) consisting of baseline data collection [2] Intervention phase (3 months) involving education on transfusion triggers and periodic mailers about good practice and designated 'transfusion resident' for supervision. [3] Post- intervention phase (6 weeks) collecting data while continuing interventions. RESULTS During pre-intervention, 379 blood components [Packed red cells(PRBC) - 227, Platelet concentrate(PC) - 78, Fresh Frozen Plasma(FFP) - 74] were requested for 280 children; 195 were transfused with an overall utilization rate of 51.5 %. PRBC had the poorest utilization rate (30 %) followed by PC (72 %) and FFP (96 %). About 79 % of the requisitions sent by residents in first training year were not utilized before intervention. Indications such as anticipated surgery, congenital heart disease, pneumonia and sepsis had lower utilization rate. Post intervention, there was 14 % reduction in blood component requests (325 requests in 258 patients). Both overall utilization rate (56 %) and PRBC utilization (37.4 %) showed improvement but the difference was statistically not significant. CONCLUSIONS Red blood cells were the most frequently requested blood components yet poorly utilized in ED. Simple interventions targeting providers in early stages of training could potentially improve the blood component utilization and transfusion practices in busy emergency departments.
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