Improving productivity, costs and environmental impact in International Eye Health Services: using the ‘Eyefficiency’ cataract surgical services auditing tool to assess the value of cataract surgical services

Abstract

ObjectiveThough one of the most common surgeries, there is limited information on variability of practices in cataract surgeries. ‘Eyefficiency’ is a cataract surgical services auditing tool to help global units improve their surgical productivity and reduce their costs, waste generation and carbon footprint. The aim of the present research is to identify variability and efficiency opportunities in cataract surgical practices globally.Methods and Analysis9 global cataract surgical facilities used the Eyefficiency tool to collect facility-level data (staffing, pathway steps, costs of supplies and energy use), and live time-and-motion data. A point person from each site gathered and reported data on 1 week or 30 consecutive cataract surgeries. Environmental life cycle assessment and descriptive statistics were used to quantify productivity, costs and carbon footprint. The main outcomes were estimates of productivity, costs, greenhouse gas emissions, and solid waste generation per-case at each site.ResultsNine participating sites recorded 475 cataract extractions (a mix of phacoemulsification and manual small incision). Cases per hour ranged from 1.7 to 4.48 at single-bed sites and 1.47 to 4.25 at dual-bed sites. Average per-case expenditures ranged between £31.55 and £399.34, with a majority of costs attributable to medical equipment and supplies. Average solid waste ranged between 0.19 kg and 4.27 kg per phacoemulsification, and greenhouse gases ranged from 41 kg carbon dioxide equivalents (CO2e) to 130 kg CO2e per phacoemulsification.ConclusionResults demonstrate the global diversity of cataract surgical services and non-clinical metrics. Eyefficiency supports local decision-making for resource efficiency and could help identify regional or global best practices for optimising productivity, costs and environmental impact of cataract surgery.

Addressing the environmental sustainability of eye health-care delivery: a scoping review

“…Studies were done in the UK, [26][27][28][29][30] the USA, 23,31,32 India, 22,23,33 New Zealand, 24,34 Malaysia, 35 Ireland, 25 France, 36 and as international collaborations (table). 38 See Online for appendix…”

“…This approach is favoured due to the limitations of existing process-based databases for health-care products such as the absence of data on the environmental costs of pharmaceuticals in lifecycle inventory databases. 41 The Eyefficiency app and some included studies implement this hybrid approach 22,34,36,38 and other studies only make use of an economic approach. 26,32 The other 14 studies included were observational and quantified the environmental impacts of interventions or clinical pathways, in some cases comparing options such as the environmental impacts of different retinal angio graphy modalities.…”

“…26,32 The other 14 studies included were observational and quantified the environmental impacts of interventions or clinical pathways, in some cases comparing options such as the environmental impacts of different retinal angio graphy modalities. 27 Six studies considered cataract surgery 22,26,28,34,36,38 and two considered intravitreal injections, 24,25 providing us with estimates of carbon costs from different settings or with different techniques and clinical pathways. Two studies explored pharmaceutical waste in eye care, 29,32 two detailed the solid waste generated by surgical procedures (one trabeculectomy 23 and one cataract 35 ), and one estimated the environmental impact of the use of sulphur hexafluoride for retinal detachment surgery.…”

“…This change complements the targeting of procurement costs, which constitute the majority of emissions. 26,34,38 Estimates for intravitreal injection identify patient transport costs as the most important factor, representing 40-77% of the non-pharmaceutical footprint, hence sustainability interventions might target longeracting medications that reduce frequency of visits, sustainable transport options, or services closer to home. 24,25…”

Ophthalmology Going Greener: A Narrative Review

“…New Zealand has the highest expenditure on consumables with low waste generation indicating that the supply spending could be disproportionately high. The UK spends moderately on their disposable supplies but generates twice as much waste compared to that of the next highest site, indicating that packaging and waste management could be an issue [ 27 ].…”