Operating room cost quality project seeks to optimize use of surgical resources, make sustainable future

Despite a push for sustainability and mindful use of surgical resources across the profession, operating rooms can contribute up to 70% of total hospital waste. By designing a targeted intervention around the average costs per surgery, researchers from the UF Department of Surgery sought to drill down the reason for increased operating room costs — and provide an avenue for changing them.

“Surgeons understand there is a substantial amount of operating room waste, and most are willing to make changes to reduce this waste,” said Amanda Filiberto, M.D., now a vascular surgery fellow at the University of Alabama. “This project was one way of showing them that we can help make that happen.”

Led by Filiberto, one of last year’s administrative chief residents in general surgery, the team began by quantifying costs for a year time period and grouping it by each division within the department. Then, they narrowed it down to individual costs per attending.

“There’s very subtle ways in which you can spend more, and it’s not always noticeable unless you’re looking for it,” Filiberto said. “But we wanted to give attendings a way to see where they stood in relation to their peers, and how much they were spending.”

Types of operating room waste include medical waste, like sharps and infectious materials, and non-medical waste, like packaging and paper products. Single-use items, like surgical instruments or unused medications, also make a dent. Substantial costs can also result from continued use or testing of newer (and not necessarily improved) surgical instruments leftover from agreements with companies in the industry.

Some of the most effective efforts ought to be directed toward reducing operating room waste with an initial focus on eliminating unnecessary waste of sterile surgical supplies, Filiberto said.

Just swapping out equipment for the standard versions across the institution, Filiberto explained, could often save the hospital thousands of dollars per surgery. One of the simple, yet effective aspects of the intervention was to provide attendings with the information needed to augment their operating room processes in a way that would benefit budget without compromising patient safety.

“In our quest to provide excellent surgical care, this initiative sought to decrease operating room supply resource use and costs without adversely affecting patient outcomes or quality metrics,” said Tyler Loftus, M.D., acute care surgeon.

In a two-month post-intervention analysis, Filiberto, Loftus and their team saw these objectives achieved — and in some cases, surpassed. Price transparency, providing data on operating room supplies, and the clarification of supplies that should be opened prior to procedures versus available if needed were key takeaways. Going forward, the team hopes to implement a process where cases with a high-cost variance are flagged in order to parse through the implants or devices responsible for significant disparities.

“Dr. Filiberto’s success in leading this project reflects not only her natural ability as a leader and learned ability to develop and implement an effective quality improvement project, but also reflects our Department faculty’s commitment to improving value of care for our patients,” Loftus said.