Barriers to efficient supply utilization in cataract surgery

白内障手术中有效利用供应品的障碍 摘要 美国每年花费68亿美元用于白内障摘除手术，这一手术消耗了医疗保险的12% 预算。不幸的是，这些支出大部分被浪费在未使用的手术用品和药品上， 在不增加价值的情况下增加医疗成本。超过90%的受访白内障外科医生认为手术 房间浪费过度。一项对白内障手术中的药物废物的研究发现，在四个设施中， 平均有45%的药物(按体积计算)在每次病例后未使用或被丢弃。其中两个设施 每一家公司每年都会丢弃价值19万美元的药物，相当于50例市价手术。这 不必要的高资源使用转化为提供商更高的总体成本，这反过来又会传递给 保险公司和病人。白内障手术和其他眼科手术不需要如此浪费和 代价不菲。对低收入国家白内障手术的研究发现，与其他国家相比， 不同的资源利用率。这些资源优化的环境重复使用手术用品，不会浪费 多剂量药物，减少成本、浪费和环境足迹，同时保持高质量的结果， 这表明，美国的白内障手术可以更有效率地进行。然而，有很多 有效实施这些战略的障碍。在最近的一项调查中，美国眼科医生引用了监管机构 要求(93%的受访者)和制造商因责任和责任而强制单一使用产品 其他动机(91%)是阻碍其安全再利用或多次手术的主要因素 补给和毒品。此外，任何对资源效率的干预都不应牺牲安全。 在这项研究的基础上，我们提议的研究旨在系统地确定 从不同利益相关者的角度，在白内障手术中实施更具资源效率的做法。 然后，我们将科学地研究两个具体的障碍-政策和安全-以促进安全和有效 向更高价值的眼科护理过渡。首先，我们将确定被认为是浪费的做法和障碍 通过采访外科医生、护士、外科技术员、管理人员和药剂师来改变 各种白内障手术设施(目标1)。全国调查和坊间证据表明， 法规和认证机构是一个主要障碍，也是对感染风险的担忧。因此，我们 将研究联邦和州一级的现有法规和政策，以准确确定哪些浪费 可以立即以安全的方式修改做法，这将需要改变现有的政策 (目标2)。最后，我们将通过测试各种单一的药物来评估来自供应和药物重复使用的潜在安全风险 术后使用产品促进微生物生长(目标3)。

Barriers to efficient supply utilization in cataract surgery Abstract The US spends $6.8 billion a year on cataract extraction, with the surgery consuming 12% of Medicare's budget. Unfortunately, much of this spending is wasted on unused surgical supplies and pharmaceuticals, adding to healthcare costs with no increase in value. Over 90% of surveyed cataract surgeons find operating room waste excessive. A study of pharmaceutical waste in cataract surgeries found that across four facilities, an average of 45% of drugs (by volume) were unused and discarded after every case. Two of the facilities each discarded over $190,000 worth of drugs every year, equivalent to 50 market-rate surgeries. This unnecessarily high resource use translates to higher overall costs for providers, which are in turn passed to insurers and patients. Cataract surgery and other ophthalmic procedures do not need to be so wasteful and costly. Studies of cataract surgery in lower income countries find comparable surgical outcomes with vastly different resource utilization. These “resource optimized” settings reuse surgical supplies and do not waste multi-dose drugs, reducing costs, waste, and environmental footprint while maintaining high quality outcomes, suggesting that US cataract surgery could be conducted much more efficiently. However, there are many barriers to effectively implementing these strategies. In a recent survey, US ophthalmologists cited regulatory requirements (93% of respondents) and manufacturers mandating single use of products due to liability and other motives (91%) as the primary factors preventing them from safely reusing or multi-dosing surgical supplies and drugs. Furthermore, any interventions toward resource efficiency should not sacrifice safety. Building on this body of research, our proposed study aims to systematically identify the perceived barriers to implementing more resource efficient practices in cataract surgery, from a variety of stakeholder perspectives. We will then scientifically study two specific barriers – policy and safety – to facilitate safe and effective transitions to higher-value ophthalmic care. First, we will identify perceived wasteful practices and barriers to change through interviews with surgeons, nurses, surgical technologists, administrators, and pharmacists from a variety of cataract surgical facilities (Aim 1). The national survey and anecdotal evidence suggest that regulations and accrediting bodies present a major obstacle, as well as concerns over infectious risk. Thus, we will research existing regulations and policies at federal and state levels to identify exactly which wasteful practices can be immediately modified in a safe manner and which will require alteration of existing policies (Aim 2). Finally, we will evaluate potential safety risks from supply and drug reuse by testing a variety of single use products for microbial growth after surgery (Aim 3).