Reducing Procedural Waste on the Internal Medicine Wards

This study was performed at The Ottawa Hospital, a tertiary academic center with over 1300 beds across two campuses. This study adhered to the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines and received an ethics waiver from our Research Ethics Board. A baseline waste audit of bedside paracentesis and thoracentesis on the internal medicine (IM) wards was performed from January to June 2023 to establish baseline waste estimates and identify opportunities for waste reduction. Interventions were developed based on findings from the first audit, in consultation with local experts and affected parties, with a goal of reducing waste by 50%. The audit was repeated from July 2023 to February 2024 after interventions were implemented. Data was collected through direct observation and by structured reporting. 1. Development and dissemination of a minimal supplies checklist: Residents were observed to use various functionally equivalent trays that differed in waste. An evidence-based minimal supplies checklist was created to standardize supplies and minimize waste (see Table 1 ). Development and dissemination of a minimal supplies checklist: Residents were observed to use various functionally equivalent trays that differed in waste. An evidence-based minimal supplies checklist was created to standardize supplies and minimize waste (see Table 1 ). 2. Optimization of the on-site procedure cart: The procedure cart was reorganized to include only the recommended supplies. Regular cart restocking was undertaken by unit administrators. Optimization of the on-site procedure cart: The procedure cart was reorganized to include only the recommended supplies. Regular cart restocking was undertaken by unit administrators. 3. “Just in Case” to “Just in Time”: To minimize waste from over-gathering “just in case” supplies, while ensuring standard of care, additional “just in time” supplies were instead readily accessible immediately outside of the procedure areas. Unused and uncontaminated “just in time” supplies were returned to the clean utility. “Just in Case” to “Just in Time”: To minimize waste from over-gathering “just in case” supplies, while ensuring standard of care, additional “just in time” supplies were instead readily accessible immediately outside of the procedure areas. Unused and uncontaminated “just in time” supplies were returned to the clean utility. 4. Educational interventions: A video demonstrating implementation of the minimal supplies list was produced and distributed to internal medicine residents. Further training was communicated through weekly e-newsletters, teaching sessions, and the clinical teaching unit orientation. Educational interventions: A video demonstrating implementation of the minimal supplies list was produced and distributed to internal medicine residents. Further training was communicated through weekly e-newsletters, teaching sessions, and the clinical teaching unit orientation. Outcome measures included the number of wasted supplies, defined as the number of unused and discarded items gathered per procedure, as well as the per procedure waste weight. Considering that the number of fluid collection bottles used per procedure varies inherently due to patient factors, a “fixed supply waste weight metric” was calculated by subtracting the weight associated with the collection bottles from the total weight. Whitney U tests with continuity correction were used to compare differences between the number of wasted supplies and fixed supply waste weight for the pre- and post-intervention audits. Pre- and post-intervention audits comprised 10 procedures each (13 paracentesis and 7 thoracentesis total). Between the two audits, there was a statistically significant difference in the primary outcomes, as shown in Table 2 . The proportion of total unused and wasted supplies per audit was successfully reduced by half, from 55.9% ( n = 292) to 24.2% ( n = 104) for the pre- and post-intervention audits, respectively.

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