“There’s more than one way to skin a cat” is one of the more bizarre sayings in the English language, if not also one of the more macabre. However, it’s a very apt description of how we do surgery. There are so many nuances to how clinicians perform an operation, all a totally acceptable standard of care and all giving excellent outcomes. Clinicians work out what works best for themselves and for their patients.
Although these different approaches all provide good quality care to our patients, they are not all equal when it comes to sustainability. Waste is an enormous issue in healthcare. Not only do wasteful practices lead to unnecessary physical waste, often depositing more plastic into the natural world already suffering under a sea of plastic, but also lead to increased greenhouse gas emissions. Wasteful practices also come at a significant financial cost, adding expense to an already financially stretched system for little or no benefit. This drives up the cost of running hospitals, public and private, and can undermine the private healthcare system leading to increased insurance premiums putting pressure on insurance rates.
The RANZCO Sustainability Committee is developing Sustainable Practice Guidelines (SPGs) for various types of procedures. The aim is to assess the different approaches taken by different surgeons when performing the same procedure for any evidence of superior outcomes and for sustainability and then to bring all these together in one place, the SPGs. This can then be used by surgeons to ensure that they are not only providing good care, but also using an evidence-based approach to provide care in the most sustainable manner. Less waste, lower emissions and less cost to the healthcare sector.
The SPGs are only recommendations, but they are evidence based where evidence is available and can provide for a more sustainable practice benefiting patients, hospitals, surgeons and the wider community. They are meant to enable surgeons to make changes, knowing that these practices have been assessed and supported by their peak body, RANZCO. Where relevant, RANZCO will also involve other key stakeholders in the development of these guidelines. Groups include those representing nurses, infection control, together with other medical colleges such as the Australian and New Zealand College of Anaesthetists (ANZCA) and the Royal Australian College of Surgeons (RACS) and international, multinational groups such as EyeSustain.
SPGs are currently near completion for both cataract surgery and intravitreal injections, with new areas hopefully to be added in the future. Once completed, they will be uploaded to the RANZCO website.
The SPGs contain a number of common themed recommendations. A simple one is to review the surgical drape type that is utilised: is it larger than it needs to be? The use of postoperative topical antibiotics in both intravitreal injection procedures and cataract surgery; the latter in the setting of the common practice of intraoperative intracameral antibiotics has enough evidence base that many clinicians and institutions have stopped using topical antibiotics following both procedures. This not only saves on waste and money but may reduce the development of resistant strains of bacteria in the community and reduce post-operative corneal epitheliopathy associated with multi-drop usage.
A common practice for identifying waste when performing surgical procedures involves looking for items opened but not used, especially those present in a standard, pre-packed set. These packs invariably come with single use items such as a speculum, caliper and forceps. As highlighted in recent studies, whether used or not, they all end up in the waste. Individuals can give this feedback to hospitals, day surgeries and suppliers, indicating that waste will be a factor in evaluating the usage and purchase of future consumables.
Apathy, a lack of awareness of the waste that we produce, and the fear of deviating from standard practice are perceived deterrents of change. Developed using an evidence-based approach and endorsed by RANZCO, the SPGs should encourage and enable change, helping to save the environment and to contain the cost of delivering the highest possible standard of medical care to the Australian community.
About the authors:
Names: Dr Michael Loughnan PhD FRANZCO; Dr Sukhpal Sandhu MD FRANZCO
Affiliations: Eye Surgery Consultants; Clinical Trials Research Unit, Centre for Eye Research Australia, University of Melbourne, The Royal Victorian Eye and Ear Hospital
Location: Melbourne (both)
Years in industry: 35; 25
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