Green Solutions for the OR - Part 2

In 2013, the Association of Women Surgeons sponsored its second Green Solutions for the Operating RoomContest in a partnership with Practice Greenhealth.  We received many innovative and creative approaches to reducing the environmental impact of the operating room.  Today we are featuring a submission from Hena Ahmed, a 2^nd year medical student at Harvard Medical School.  Hena’s submission describing her OR RecylingProject  won second place in the contest.  Congratulations, Hena!

Innovation in Practicing Cost-Saving Health Care

Using technology to reduce health care waste and deliver supplies to resource poor communities

by Hena Ahmed

A plastic bottle can sit unchanged in a landfill for decades. The same is true for single-use plastic devices in operating rooms. Consider the trajectory of equipment in today’s operating rooms: many of these devices are opened as part of surgical kits but not always used. Due to current hospital policies, these items are discarded after each procedure, perfectly intact. A discarded suture kit could sit in a landfill for decades, or be used to repair a wound in a low-income community.

As a first year medical student, I became interested in the intersection between resource recovery, global health delivery, and health care expenditure. In an era of rapidly rising health care costs, I developed an interest in finding a win-win-win solution for recovering and redirecting materials in hospital operating rooms while supporting health care delivery in resource poor settings. This resulted in the creation of the Medical Resource Delivery Project at Harvard Medical School.

With experience as an undergraduate in collecting supplies for global health projects, I found that a bottleneck for global health delivery often occurs at the level of resource and medication procurement to support projects abroad. Through my interaction with physicians interested in global health, I discovered a demand in other countries for recoverable resources from health care settings in the U.S.

Operating rooms are one of the main sources of hospital expenditure and waste generation. Despite efforts to reduce resource usage, operating rooms have limited data-driven assessments of their daily energy and equipment usage. Evaluation of these practices rests on yearly assessments. However, real-time data collection using mobile technology can improve practice and reduce waste.

Recovery programs currently in place, including at MGH and through nonprofits such as Remedy Inc, and the Afya Foundation, do not generate resources in a sustainable manner. These programs also have minimal tracking of their supply collection and shipping to other organizations. I developed a mobile application that would allow us to track recoverable materials from operating rooms. The purpose of the application is to use quick-response codes, similar to barcodes but customizable to individual items, linked with cloud-storage spreadsheets powered through Google Docs. The items that are collected are then shipped to nonprofit organizations. The application not only eliminates the need for manual tracking of supplies, but also allows us to understand the monetary value of the supplies being discarded and recovered. On a daily basis, surgical departments would be able to track both their resource consumption and their waste generation, while also tracking materials that are available for recovery. Hospital administrators would find this data invaluable as they work to target hospital costs that do not directly impact patient care and outcomes.

So how exactly does this application work? (Figure 1).

Figure 1. Process of Operating Room Resource Recovery

In just two years and in only two operating rooms, the application found more than $31,000 of materials that were recoverable from procedures in the obstetrics and gynecology floors at Massachusetts General Hospital (Figure 2).

Figure 2. Materials Recovered in Operating Rooms ($)

The findings were documented and presented at the 2013 Association of Women Surgeons Conference in Washington, D.C. The project was also recognized with an award in the Green Solutions for the Operating Room Contest.

The application continues to generate interest among the environmentally conscious surgeons, and our group recently partnered with UCSF School of Medicine and the Cleveland Clinic to implement the technology in their operating rooms. Future goals of the project include expanding to other operating rooms in MGH as well as other hospitals around the country, and partnering with nonprofit organizations to create sustainable delivery programs.

Ultimately, limiting waste is a key goal of operating rooms and hospitals across the country, and by implementing technology that allows for real-time evaluation and data collection, we can ultimately improve health care practice while simultaneously supporting health care delivery in global health settings.

About the author:

 Hena Ahmed is a second year M.D. candidate at Harvard Medical School. A native of Indiana, she graduated from Indiana University with highest distinction and Phi Beta Kappa in 2012 with a B.S. in neuroscience and a B.A. in chemistry. She co-founded Global Medical Brigades at Indiana University and collected over $100,000 in funding for two brigades to Honduras, forming the largest global health organization on campus. Her interest in neurodegenerative disease led her to complete an honors thesis in neuroscience as a 2011 Beckman Research Scholar. As a medical student, she received the 2012 Bertarelli Foundation Fellowship in Neuroscience and support to conduct a translational neuroscience project in Lausanne, Switzerland. She founded the Medical Resource Delivery Project at HMS through which she worked at Massachusetts General Hospital to build a mobile application aimed at collecting and delivering unused equipment to resource-poor communities. Hena is ultimately interested in the intersection of neuroscience and global health. She hopes to pursue a clinical career in surgery and impact health outcomes in the U.S. and globally. In her free time, she enjoys oil painting.