Operating rooms produce on average more than 2,000 tons of waste per day, and a significant portion of that waste is from disposable medical supplies.
And those estimates come from a small sample since there is a limited research that measures OR waste and how it is accumulated, said James Yoon, an author of a recent study from the University of California, San Francisco that analyzed waste in the OR of the hospital's neurology department.
The recent study, published in the Journal of Neurosurgery, found that an average of $968 worth of disposable medical supplies in the operating room are wasted per procedure in UCSF's neurosurgical department. That amounts to $2.9 million per year.
The researchers tracked unused and wasted supplies during 58 neurosurgical procedures in August 2015. They observed a variety of surgeries including craniotomies and brain tumor resections.
The average total cost of those procedures ranged from $8,377 to $9,578, and about 13% of the total surgical cost was spent on unused or wasted supplies.
Commonly wasted supplies were low-cost items like sponges, gloves and sutures. But, the researchers found the most costly waste comes from higher-cost supplies that are used less often like screws and sealants.
The study found wide variation to predict surgical supply waste. The procedure type significantly affected unused supply waste. For example, unused supply waste was more common in tumor procedures, at 19.7%, compared to spinal cases, which was at 7.18%.
Waste also varied by surgeon. One spine surgeon wasted 1.9% of supplies on average per procedure compared to another surgeon who wasted 23.6% of supplies on average. The study didn't find a correlation between waste produced per procedure and the experience of a surgeon.
Waste is difficult to control because it is hard to predict the supplies a surgeon may need for a procedure, particularly a complicated one, Yoon said. “We try to be prepared for as much as we can but there are a lot of things we can't foresee and those are the occasions when waste can happen,” he added.
The surgeons have since implemented several measures to curb waste. UCSF has promoted price transparency by showing doctors their median surgical supply cost for each type of operation performed in the prior month compared to all UCSF surgeons' baseline performance. This tactic is used in the departments of neurosurgery, orthopedic surgery and otolaryngology.
Dr. John Toussaint, CEO of the ThedaCare Center for Healthcare Value, which advises healthcare executives about eliminating wasteful or inefficient processes, said presenting surgeons with their costs is a highly effective way to reduce waste. “Doctors are competitive so if there is somebody who can do a procedure at a higher quality and a lower cost than them, they're going to try to get to that same level or better,” he said.
The academic center has also held meetings to educate nurses and surgeons about the degree of OR waste and cost of high-cost items. The goal is to help nurses and surgeons determine together which items will be needed before procedures.
UCSF currently is reviewing physicians' preference cards to remove unnecessary items and to get clarification from nurses which items should be opened in the sterile field or simply available in the OR.
Encouraging physicians to critically review their physician preference cards is an effective tactic to reducing waste especially if it done together with other surgeons, said Kaeleigh Sheehan, member engagement manager of Practice Greenhealth, a not-for-profit organization that promotes hospital sustainability.
Sheehan added that another tactic more hospitals are using is reprocessing single-use medical devices by partnering with a third party vendor that disassembles and sterilizes devices. “There was that mindset in the 1980s that disposable is better,” Sheehan said. “People thought disposable meant there was no chance something could affect patient care but now we're starting to come back (to reprocessing).”
