Each year, millions of people walk through the doors of a hospital on their way to become surgical patients. For each of those procedures, there is a careful plan that includes who will staff it, what supplies with be used, where it will take place and for how long. Materials need to be reprocessed, sterilized and packaged in sets for surgical teams to easily and safely access.
Despite the extensive planning that goes into surgeries, there is also a lot of avoidable waste that is produced. In fact, the OR is one of the biggest producers of waste in a healthcare organization, generating an estimated 20-30% of the overall waste.1 That waste amounts to an annual cost of $15 billion.2
When it comes to OR waste, there are two types – product and operational. Product waste encompasses things like discarded unused materials, un-needed items being packaged with needed items in instrument sets and items opened in error or in anticipation of being required for a procedure. Operational waste stems from inefficiencies in communication and coordination and limitations in supply or staff resources.
These types of waste can often compound one another and lead to delays in surgeries, which have cascading effects such as backlogged surgical cases, booking errors and inefficient scheduling.
Luckily, there are some clear methods to increase efficiency and reduce cost while prioritizing patient safety, which include:
- Be more transparent about cost: Sometimes, there can be a lack of awareness about what materials such as case carts and items on procedural set up cards actually cost. Consider labeling supplies with their cost, as it might prompt the person gathering them to pause before choosing to use it. Also think about delivering cost feedback to surgeons about the materials they’re requesting. Given the competitive nature of surgeons, creating a healthy competition on driving down unnecessary material use could prove beneficial.
- Keep preference cards up to date: Surgeon’s preference cards are a powerful tool that influence everything from purchasing supplies through procedural set up in the OR. If they’re outdated or inaccurate, that can lead to significant product and operational waste, as well as compromise patient safety. For example, if an item is missing and the OR circulator needs to exit to retrieve it, not only does it remove someone from the patient’s care, but it poses an infection control risk by opening the OR door to outside contaminants.
- Lean on data: Inefficient tracking is another common underlying cause of OR waste. There are many analytics tools available that can capture data points such as room time, room utilization, turn over time and volume. The tools can run frequency reports, conduct inventory evaluations and clearly display purchasing history. The data can also help by pointing to any correlations between clinical staff or a procedure and the use of excessive materials, as well as identify an underlying work flow issue. If you can, chart with graphs as well so you can easily see outlying data points.
- Foster open lines of communication: Even in optimal conditions, there are always unforeseen circumstances when running a busy OR program that can interfere with clear and proactive communication. The top two reasons for communication errors during intraoperative care were related to equipment (36%) and keeping team members informed of the progress of an operation.3 For example, if one surgery is running long, sharing that information broadly in as close to real time as possible can prevent another OR from being prepped for a procedure too soon. This is important because that delay can cause multiple room changes, which could render the materials in the prepped room unusable.
- Take time to observe: Observation is a much more effective tool than it seems. It can be surprising what you learn when you take the time to methodically look at the process steps of preparing an OR for surgery chronologically, paying attention to things like who’s doing the tasks and whether it’s the right person. For example, is the proper person picking the materials for the procedure or setting up the OR?
As hospitals and healthcare facilities are operating in an environment in which reimbursement models are changing and increasingly tied to patient outcomes, surgical services leadership is paying more attention to potential cost savings that don’t compromise patient safety. Taking a measured approach rounded in observation, solid communication, cost transparency and data can help to reduce OR waste and ensure that your facility is able to continue delivering safe, high-quality care to its patients.
- Axelrod D, Bell C, Feldman J et all. Greening the Operating Room and Perioperative Area: Environment Sustainability for Anesthesia Practice. American Society of Anesthesiologists; 2017
- Peregrin T. Strategies for sustainability: going green in the OR. American College of Surgeons. May 2015. http://bulletin.facs.org/2015/05/strategies-for-sustainability-going-green-in-the-or/ Accessed Jan. 18, 2019
- Halverson et al, Communication failure in the operating room, Surgery. 2011 Mar;149(3):305-10. https://www.ncbi.nlm.nih.gov/pubmed/20951399