I tell my team “services that end in urgery” are high priority.  This is where care is most critical and resource use is highest.  CFOs say margins are made in the OR, particularly in elective and commercial insurance cases.  It is a scary place, too- knives, blood, humans and robots wrapped in PPE like extra-terrestrials!  CEOs tread lightly for fear of angering their surgeons.  Salty OR staff bark because preparedness saves lives.  Other departments scurry through to avoid bunny suits and getting a glimpse of it all!  Oh, and ORs are wasteful.

The financial opportunity is substantial.  One assessment we completed found savings of $250,000–$588,000 across 10 ORs, with the largest opportunities concentrated in HVAC optimization, device reprocessing, surgical-pack redesign, and waste segregation.  Importantly, these savings were identified at a facility that had already implemented significant sustainability measures—including 100% LED lighting, approximately 70% solar-sourced energy, desflurane elimination, HVAC setbacks, extensive device reprocessing, and reusable gowns. The implication for less mature surgical programs is huge!

We also found over $100,000 in annual savings in a single specialty ASC by focusing on each step of the surgical flow and a thorough energy audit.  Today, because of the intense demand for electricity due to data centers, many utilities are focused on incentives to reduce demand from their high energy users- aka hospitals.

Common questions and metrics for a Green OR:

1. Has the OR eliminated desflurane from the formulary? It’s expensive with high pollution!
2. Is nitrous oxide (N2O) been decentralized?
3. Are preference cards updated annually?
4. What is the regulated medical waste pounds per case?
5. What is the energy (natural gas & electricity) cost per case
6. Are OR room temperature setbacks (increase in temperature) when not in use?
7. Is air flow reduced when not in use after hours and weekends?
8. What percent of lighting is LED?
9. Are occupancy light sensors used in non-clinical areas?
10. Have you contacted your utility to identify energy rebates?
11. What is the greenhouse gas emissions per case?
12. What percentage of electricity used is renewable?
13. Do clinicians use reusable masks and gowns?
14. Is there an opportunity to reduce patient draping by case/physician preference?
15. Are SPD surgical trays reviewed annually?
16. What is the cost of blue wrap and is there a blue wrap reduction and recycling plan?
17. What is the number of cases that use reprocessed devices vs. single use
18. Do the top 50 OR vendors and top 50 products have a sustainability plan?
19. Are surgical patients asked if they value sustainable hospital practices?
20. What suggestions do OR techs and nurses have for sustainable surgery?
21. Have residents been engaged in sustainability tactics in their specialty?

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