Dr Kiran Narula1, Ms Helen Douglas1, Mrs Carina Doran1, Dr Justin Bui2, Ms Esther Dawkins3, Prof Fiona Wood1, Prof Suzanne Rea1
1State Adult Burns Unit, Fiona Stanley Hospital, Perth, Australia, 2Medical Education Unit, Fiona Stanley Hospital, Perth, Australia, 3Institute of Health Leadership, Department of Health, Perth, Australia
Background:Between 20-70% of all hospital waste comes directly from the operating room. Up to 90% of this waste is improperly sorted and sent for costly hazardous-waste processing. Using the Define, Measure, Assess, Improve, Control (DMAIC) model of service improvement, the use of consumables and surgical instruments in our theatres were assessed to estimate environmental and financial waste.
Methods: All surgical procedures performed in adult burns and general surgery theatres over a 4-week period were directly observed, recording number of all consumables (e.g. drapes, bandages, blades) opened and used. The surgical instruments used during the case was also recorded and confirmation of all numbers checked with the scrub nurse and surgeon at the conclusion of the procedure.
Results:Fourteen minor burn (<10% TBSA) operations and 22 general surgery operations were reviewed. In burns theatres 15% (n=113) of consumables opened went unused. In general surgery theatres 29% (n=298) of consumables opened went unused.
Regarding surgical instruments on the tray; in the burns theatre an average of 7 instruments (95% CI ± 1.8; range 0-13) out of 30 were used in each operation whilst in the general surgery an average of 13 instruments (95% CI ± 1.5; range 6-16) out of 24 available were used.
Discussion: Improving efficiency, choosing wisely and eliminating unnecessary waste are concerns for healthcare organisations globally. Reviewing usage of theatre consumables and surgical instrument trays can reveal opportunities for improvement. The use of pre-operative planning strategies, effective surgical briefs and regular audit can assist this process.
Kiran is a surgical registrar at Fiona Stanley Hospital. He holds an interest in clinical redesign.