Anesthesia providers can help reduce the financial and environmental waste they create in the OR.
A quality improvement project at the University of California San Francisco not only identified obstacles to reducing such waste, but provided clinicians with concrete steps they could take to address these shortcomings.
“The University of California Health System has an overarching goal to make itself sustainable,” said Wilson Ly, MD, PharmD, MS, the chief anesthesia resident at the San Francisco health system. “Last year, we initiated a quality improvement project to examine how we can reduce environmental and financial waste in the OR.
“We developed a survey with the goal of understanding anesthesia providers’ cost awareness, as well as their preferences for choosing high-cost medications and single-use OR supplies over less expensive and lower carbon footprint alternatives,” Dr. Ly added.
With this in mind, the anonymous electronic survey was distributed to 341 anesthesia providers at the institution, including attending anesthesiologists, CRNAs, residents and anesthesia technologists. As part of the survey, respondents were asked to estimate the costs of 12 commonly used medications and single-use supplies. They were also asked to provide their reasons for choosing higher-cost supplies.
The researchers used descriptive statistics to analyze cost estimations, while the free-text provider preferences for medications and single-use supplies were examined by semantic analysis to identify common influences.
Guesstimates Found Not Accurate
In a presentation at the 2022 virtual annual meeting of the International Anesthesia Research Society (abstract 822), the researchers reported that 129 completed surveys were received, for a response rate of 37.8%. Among these, it was found that the correct price estimation on selected medications and single-use supplies ranged between 16% and 64%, with a mean of 31.1% (Table).
Interestingly, respondents’ accuracy in estimating product prices did not correlate with years of clinical experience.
“Providers did a pretty poor job of knowing the price of the things they use every day,” said senior author Priya Ramaswamy, MD, MEng, an anesthesiologist and the chief clinical informatics fellow at the institution. “If you ask most Americans the average cost of a loaf of bread, they would be able to tell you. But anesthesiologists use a bag of Ringer’s lactate every day for the majority of their patients, but still can’t tell you how much it costs. I think that’s a problem, and should motivate us to train our colleagues and trainees on the cost of the items they use every day.”
The increased cost of some items often accompanies increased environmental waste, such as that seen with single-use items.
Choices Affected by Patient Safety, Work Culture
When the researchers examined the reasons that clinicians turn to specific high-cost medications and/or single-use supplies instead of less expensive alternatives, they found several common themes. Reasons included concerns about medication efficacy, side effects of drugs, drug–drug interactions, patient comorbidities and departmental work culture.
“Patient safety is always our primary goal and we certainly don’t want to take that away,” Dr. Ly noted. “That said, there may be perfectly reasonable—and less expensive—alternatives, especially for something like a T-piece connector instead of a six-port nanoclave.”
The survey has served as a springboard for bringing change at the institution.
“The study has really helped catapult our department’s goals of trying to reduce some of its waste,” Dr. Ramaswamy said. “We shared the results of the survey with the department, which we believe will help them make more informed decisions going forward.”
The institution has also implemented a unique way of demonstrating price transparency for its clinicians.
“One of the other members of our team has made a price card for every operating room, which goes beyond anesthesia to include all OR supplies,” Dr. Ly explained. “I think transparent measures such as these will help health systems make more conscious choices in the future.”
Drs. Ly and Ramaswamy reported no relevant financial disclosures.
This article is from the September 2022 print issue.