LAUSR

Anaesthesia is a waste-intensive specialty, mainly because of the use of many disposable products. Waste production in anaesthesia is not consistent though, and this may be partially related to variation in the type and quantity of disposable products used to provide anaesthesia care. We undertook an observational study to identify factors related to waste and cost during anaesthetist-provided sedation for gastrointestinal endoscopy in our hospital. We felt that although differences in waste (and cost) for any given case might be relatively small, the cumulative total might be potentially significant. Following approval by the University of Tasmania’s Human Research Ethics Committee (Project ID: 23043), a prospective observational study was conducted at the Launceston General Hospital, Australia, from 15 October to 19 November 2020. We included 57 patients, 13 anaesthetists and nine gastrointestinal endoscopists, each providing consent to participate. The primary outcome was waste generated permin of sedation time. Cost was also estimated. Eligible patients were adults with American Society of Anesthesiologists physical status class 1–3, who were not pregnant, presenting for elective upper or lower gastrointestinal endoscopy under anaesthetist-provided sedation. They were between the ages of 23 and 88 years, being 58% male and 42% female. Thirty-nine percent of the cases had an upper gastrointestinal endoscopy alone, 51% had colonoscopy alone and 10% had both. The anaesthetists included a mix of eight consultants, one senior anaesthesia trainee, two junior anaesthesia trainees and two other junior doctors in anaesthetic rotations. They were advised not to alter their usual sedation practice during the study. The term ‘lead anaesthetist’ is applied to any anaesthetist, irrespective of seniority, who led at least one sedation case. Included waste was from disposable drug and fluid products used by anaesthetists for anaesthetic care purposes. It did not include waste from airway equipment, personal protective equipment or products administered for endoscopy purposes. An independent observer completed an inventory of disposable drug and fluid products administered during each sedation. The observer collected data on eight days mostly by convenience sampling. The weight (grams) of waste of each item was obtained using a digital weighing scale while costs (in Australian dollars) were independently supplied by the hospital pharmacy and stores staff. After all cases had been completed, anaesthetists were asked via a de-identified electronic survey about their motivating factors for choosing disposable products and their willingness to change practice to reduce waste if it did not affect clinical outcomes. The descriptive analysis involved calculating medians, interquartile ranges and ranges for waste and cost production overall, and for subcategories of various disposable product choices. Average waste and cost production during and beyond the first ten min of sedation, and average sedation time were also calculated. This study found a large range in waste production permin of sedation (0.66–21 g/min) among anaesthetists from disposable drug and fluid administration products used to provide sedations for elective gastrointestinal endoscopies (Table 1 and Figure 1). A large