Methods and evaluation metrics for reducing material waste in the operating room: a scoping review.
Methods and evaluation metrics for reducing material waste in the operating room: a scoping review.
复制标题
减少手术室材料浪费的方法和评估指标：范围审查。
DOI：
10.1016/j.surg.2023.04.051
复制
发表时间：
2023
期刊：
影响因子：
3.8
通讯作者：
Loftus,TylerJ
中科院分区：
文献类型：
--
作者：
Balch,JeremyA;Krebs,JonathanR;Filiberto,AmandaC;Montgomery,WilliamG;Berkow,LaurenC;UpchurchJr,GilbertR;Loftus,TylerJ
背景手术室产生的废物占医院废物总量的 70%。尽管多项研究表明通过有针对性的干预措施减少了浪费，但很少有人研究过程。本次范围审查重点介绍了外科医生采用的手术室废物减少策略的研究设计方法、结果评估和可持续性实践。MethodsEmbase、PubMed 和 Web of Science 筛选了手术室特定的废物减少干预措施。废物被定义为有害和无害的一次性材料和能源消耗。根据研究设计、评估指标、优势、局限性和实施障碍，按照范围界定审查指南的系统审查和荟萃分析扩展的首选报告项目将研究特定要素制成表格。结果总共分析了 38 篇文章。其中，74% 的研究有干预前与干预后设计，21% 使用质量改进工具。没有研究使用实施框架。绝大多数（92%）的研究将成本作为结果来衡量，而其他研究则包括按重量、医院能源消耗和利益相关者的观点计算的一次性废物。最常见的干预措施是器械托盘优化。实施的常见障碍包括缺乏利益相关者的支持、知识差距、数据采集、额外的员工时间、对医院或联邦政策的需求以及资金。很少有研究（23%）讨论了干预措施的可持续性，包括定期废物审计、医院政策变化和教育举措。常见的方法学局限性包括有限的结果评估、狭窄的干预范围以及无法捕获间接成本。结论质量改进和实施方法的评估对于制定减少手术室浪费的可持续干预措施至关重要。通用评估指标和方法可能有助于量化废物减少举措的影响并了解其在临床实践中的实施情况。
BackgroundOperating rooms contribute up to 70% of total hospital waste. Although multiple studies have demonstrated reduced waste through targeted interventions, few examine processes. This scoping review highlights methods of study design, outcome assessment, and sustainability practices of operating room waste reduction strategies employed by surgeons.MethodsEmbase, PubMed, and Web of Science were screened for operating room-specific waste-reduction interventions. Waste was defined as hazardous and non-hazardous disposable material and energy consumption. Study-specific elements were tabulated by study design, evaluation metrics, strengths, limitations, and barriers to implementation in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.ResultsA total of 38 articles were analyzed. Among them, 74% of studies had pre- versus postintervention designs, and 21% used quality improvement instruments. No studies used an implementation framework. The vast majority (92%) of studies measured cost as an outcome, whereas others included disposable waste by weight, hospital energy consumption, and stakeholder perspectives. The most common intervention was instrument tray optimization. Common barriers to implementation included lack of stakeholder buy-in, knowledge gaps, data capture, additional staff time, need for hospital or federal policies, and funding. Intervention sustainability was discussed in few studies (23%) and included regular waste audits, hospital policy change, and educational initiatives. Common methodologic limitations included limited outcome evaluation, narrow scope of intervention, and inability to capture indirect costs.ConclusionAppraisal of quality improvement and implementation methods are critical for developing sustainable interventions for reducing operating room waste. Universal evaluation metrics and methodologies may aid in both quantifying the impact of waste reduction initiatives and understanding their implementation in clinical practice.