Highlights: What are the main findings? Using the HSMEA, it is possible to systematically reduce operating room waste. The HSMEA identifies carbon hotspots of surgical waste based on waste stream analysis. Solutions for improvement are found by applying the six Rs of waste management. What is the implication of the main finding? A reproducible efficient approach to improve operating room sustainability. A structured and practical tool to reduce the environmental impact of surgical solid waste. The purpose of this study was to describe a new method to effectively improve the environmental impact of operating rooms through a systematic approach. A proven successful prospective risk analysis tool to improve the safety of complex healthcare processes (Healthcare Failure Mode and Effect Analysis) was adapted to reduce the environmental impact of surgical waste. For this novel method, named the Healthcare Sustainability Mode and Effect Analysis (HSMEA), a multidisciplinary team, using a structured step-by-step approach, systematically inventories surgical waste, quantifies its environmental impacts, identifies hotspots, and provides solutions for improvement. The five steps of the HSMEA are described (definition of the topic, team assembly, flowchart creation, hazard analysis, actions and outcome measures) and the surgical procedure of a caesarean section was used as a case study to assess the applicability of this method to improve its environmental impact. Applying the HSMEA to caesarean sections resulted in a 22% volume reduction and a 22% carbon footprint reduction in surgical waste. This was achieved by revising the disposable custom pack in order to reduce the overage that was present, and by intensifying waste stream segregation for plastic and paper recycling. The HSMEA is a practical work floor tool to aid in the reduction of the environmental impact of surgical waste that is applicable to all types of operations. It is reproducible, and because it identifies carbon hotspots, it enables an efficient approach to the issue of operating room pollution.

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More than a million times every year, an ambulance is deployed in the Netherlands. Of these instances, 87% of the patients will be administered intravenous (IV) fluids. In the current situation, the IV bag always needs to be held above the patient to function properly. This action requires an extra pair of hands, which is very inefficient and can result in the loss of precious time that could otherwise be directed at the patient. Besides needing an extra pair of hands, there is also a chance of air bubbles entering the patient through the drip feed. The novel drip chamber design proposed in this paper aims to solve these problems, as it enables the IV bag to be placed in any orientation and in any manner relative to the patient with a negligible number of air bubbles entering the drip feed. This novel drip chamber was tested in an experimental setting in different orientations and at different flowrates. From the test results, it can be concluded that at a clinical relevant flowrate, a negligible number of air bubbles were present within the IV system. Because of the ease of use of the novel drip chamber and the fact that it is fool-proof, cost-efficient, and shows promising test results, future research on several aspects could make this product a promising addition to health care.

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Patient-centred care is becoming more important in healthcare. The success of patient-centred care can be assessed by exploring the patient experience through a patient journey map. As the number of outpatient surgeries is increasing, it is important to reveal the specific characteristics of this type of surgery. The perioperative patient experience is considered very important for outpatient surgery, because all perioperative activities are condensed in one day. To investigate this experience, we performed a case study of hand and wrist surgery. Six teams of two industrial design engineering students interviewed 40 patients in total in two private and two public hospitals in the Netherlands. All teams created a patient journey map, describing the patient experience. These maps were analysed by the authors to identify common themes among the six journeys. Four time-independent themes and four time-dependent themes were identified. Insecurity, reassurance by staff, loneliness, and lack of information were associated with the whole patient experience. Before surgery, lack of control was the most prominent experience. During surgery, acceptance and curiosity were present. After surgery, relief was the dominant experience. No significant differences between the public and private hospitals were discovered. Several suggestions are given on how to facilitate positive experiences and how to resolve negative experiences in outpatient surgery. These include suggestions for hospital policy and design interventions.@en