An instructional course titled “Sustainability in Ophthalmology: Decrease Costs and Waste While Increasing Quality of Healthcare” was held on Day 2 of the American Society of Cataract and Refractive Surgery (ASCRS 2022). We attended and covered this course as part of our continued coverage of this important topic.
We know the medical field — including ophthalmology, and especially cataract surgery — produces a lot of unnecessary waste. In a previous article, we covered the “why” to explain the reasons driving this behavior; now, we look at what can actually be done at an individual clinic level to reduce waste (and thereby cut cost) while delivering the same high quality of care.
What can YOU do?
Noting that procurement is the main driver of carbon emissions in cataract surgery, Dr. Cathleen McCabe shared ideas on how ophthalmologists can incorporate more sustainable practices — solutions that can not only help to save the planet, but also save money, too.
One simple solution is to assess all the items used in a single patient case and determine which of those within the surgical pack are not even being opened, said Dr. McCabe. “They’re not being used, they’re not being opened, they’re just being thrown out. And to me, this is such a simple place to start in your own practice because you can look in your pack and see [what you actually use and decide if it needs to be in every single pack],” she explained.
Removing unnecessary supplies can make a significant financial impact: “At UCSF (in neurosurgery) they did this … and when they saw what was being unused, they were able to see that they would save $2.9 million annually — and these are real dollars — just by not putting things in the pack that weren’t being used every time.”
What else can you do? Dr. McCabe said that reprocessing instruments can help divert one million pounds of waste from landfills.
“This saves money — it decreases the actual number of things you have to buy if you’re reusing what you already have. It decreases staff time in ordering, tracking the supplies and accepting the shipping, it decreases storage space (which is a huge thing), it decreases garbage … and importantly, as we’ve seen over the last few years, [it decreases the] risk of disruption to the supply chain,” she continued.
She shared that Kaiser-Permanente is one example of how sustainable initiatives can reduce costs: They switched from single-use sharps containers to reusable ones and saved $1.7 million annually.
“It’s a win-win. If you look at all these things that you can manipulate in order to be more environmentally responsible, they’re fiscally responsible as well,” explained Dr. McCabe.
Reducing office waste is another way to be more environmentally friendly. Using fewer paper products and turning off lights and computers is one easy way to reduce a clinic’s carbon footprint.
“Talk to your supplier or rep … they will understand that these are things that you care about,” she said. And there’s power in numbers: Working with societies like the ASCRS can also make a difference to show industry partners that this is important.
Dr. McCabe concluded with this reminder: “[As a physician] you’re the leader in your environment … and it sets the tone that we should care about these things. Having one champion in your office or OR can make all the difference — and it really does take someone who wants to take action.”
Artificial Intelligence to the Rescue
“Decarbonization, in essence, is a big data problem — we have so much going on all the time, and who has the time to sit and analyze every piece of this data,” said Dr. Gitanjali Baveja, an ophthalmologist from Virginia and CMO of Zasti, Inc. “What we can do is leverage artificial intelligence to do this — to help us determine our baseline, and once we determine our baseline, that’s the only time we can implement real changes to make a difference, reduce cost and improve overall environmental impact.”
After all, how can you reduce your carbon footprint if you don’t know what it is?
Dr. Baveja continued that once the baseline is identified, tracking how the practice is doing over time and looking at sustainable efforts longitudinally is very important — and that’s where AI comes into play. She then shared information about Zasti, a “carbon tech” company, and its proprietary technology ATOM (Assess, Target, Optimize, offset and Monetize) which was developed to help reduce the healthcare industry’s carbon footprint.
Resources to Make Clinics More Sustainable
“We know that the OR is the main contributor of medical waste, but our medical offices also create emissions and many of us spend as much or more time in the clinic as we do in the OR,” said Dr. Aaki Shukla. “Importantly, there’s less regulation in the clinic than in the OR [so these changes are easier to implement].”
Dr. Shukla shared a simple quiz to help assess clinical waste, with questions like: “Are the lights or HVAC on 24/7? Is clinical waste sorted? How often are patients coming in for unnecessary post-op visits?”
To make clinics more sustainable, there needs to be a high level of commitment from leadership to green sustainable practices. “We need to raise staff awareness and engagement … and we want to identify and implement opportunities — there will be situations unique to your clinic that you want to leverage. And you want to take the message forward to other groups and practices,” she explained, adding that MyGreenDoctor — a non-profit environmental sustainability management program for medical offices — is a great way to get started.
“It includes 140 steps and educational tools that you can take to improve your office. Topics covered in this program (for just the first year) include energy savings, recycling, patient education, green cleaning, healthy foods, water use, transportation choices — really the full gamut of information on this topic,” said Dr. Shukla. “This program can potentially save practices up to $1,500 per doctor per year with no incremental dollar investment necessary.”
[Editor’s Note: ASCRS and ASOA members can access MyGreenDoctor.org for free through their society membership using the codes MGDASCRS and MGDASOA.]
Another resource (that had a timely launch on Earth Day 2022) is EyeSustain.org, which is described as a global coalition of ophthalmology societies seeking to collaborate on making ophthalmic care and surgery more sustainable, both environmentally and economically through engagement, collaboration and support.
Editor’s Note: ASCRS 2022 is being held April 22-26, as a physical show in Washington DC, USA. Reporting for this story took place during the event.