HA 695 Unit 1 problem scoping paper example

$182 a Case Opened and Thrown Away: Scoping a Capstone Project on Unused Disposable Supplies and Outdated Preference Cards in a Nine-Room Operating Room

Student Name

Health Care Administration, Herzing University

HA 695: Graduate Capstone Project

Instructor Name

January 15, 2026

$182 a Case Opened and Thrown Away: Scoping a Capstone Project on Unused Disposable Supplies and Outdated Preference Cards in a Nine-Room Operating Room

The Problem in One Sentence

In the main operating room of Ridgeway Medical Center, a composite 260-bed community hospital, sterile disposable supplies opened for surgical cases but never used cost an average of $182 per case in an October 2025 audit, about 12% of disposable supply spending, which at 8,900 cases a year is roughly $1.6 million of supplies discarded each year.

The Size of It, From Ridgeway's Own Data

The figure comes from a four-week audit in October 2025. Two perioperative nurse educators observed 120 cases across all nine rooms and the six largest surgical services, recording every disposable item opened onto the sterile field and whether it was used before the end of the case. Item costs came from the hospital's supply catalog. Across the 120 cases, the cost of opened-but-unused items averaged $182 per case, with a median of $118 and a range from $0 to $1,240; disposable supply cost averaged $1,540 per case, so waste was 11.8% of it. Spine and orthopedic cases carried the highest waste per case, general surgery and gynecology the lowest.

A second source points to a cause. Each surgeon has a preference card for each procedure listing the supplies to be pulled and opened. Ridgeway's perioperative information system holds 1,412 active cards. The audit of card dates found that 38% had not been updated in more than two years, and 214 belonged to surgeons who no longer operate at Ridgeway. Staff told the educators that they open what the card lists, even when they expect it will not be used, because an item not opened when a surgeon asks for it delays the case.

Ridgeway's results are in line with published observations. A study of neurosurgical procedures found unused supplies averaging $653 per case, 13.1% of surgical supply cost (Zygourakis et al., 2017), and a French study of routine procedures found wasted supplies reaching about a fifth of the supply cost allocated to some procedures (Chasseigne et al., 2018).

What the Project Covers

In scope: disposable supplies opened onto the sterile field in the nine main operating rooms; the content and upkeep of preference cards for the procedures most responsible for waste; the practice of opening items in advance versus holding them unopened in the room; and whether surgeons and staff see the cost of what is opened.

What It Leaves Out

Out of scope: implants, whose selection is driven by surgeons and vendor contracts and priced separately; the ambulatory surgery center; purchasing contracts and unit prices; and the environmental impact of waste, which matters and would benefit from the project but is not what it measures.

The adjacent problem I would rather solve, and cannot, is instrument tray content. Many reusable trays carry instruments that are rarely used but must be cleaned, inspected and sterilized every time, and tray optimization has produced large savings elsewhere (Farrelly et al., 2017). But trays involve sterile processing, every surgical service and instrument counts that affect patient safety, and a tray project could not be designed and evaluated inside one term alongside this one. Disposable waste can be measured case by case, is seen every day by the staff and surgeons in a position to reduce it, and is a fair test of whether Ridgeway can change surgeon preference practices at all, which a tray project would later depend on.

Stakeholders

Who feels the problem: circulating nurses and surgical technologists, who open, dispose of and restock supplies and who are blamed when an item is not ready; the supply chain department, which carries the cost; and, indirectly, patients, whose bills and whose hospital's finances absorb it.

Who would pay for a fix: the vice president of perioperative services, who holds the budget for staff time and information system changes, with the chief financial officer as the sponsor of any savings target.

Who could block one: surgeons, whose preference cards are theirs and who may see changes as interference in how they operate; the chair of surgery, who can make or break surgeon engagement; and the perioperative nurse manager, whose staff would change how they open and hold supplies.

Who holds the data: the perioperative information systems analyst, who controls preference card records, and the supply chain analyst, who controls item costs.

Why This Problem, and Why Now

Three conditions make this the right time. First, Ridgeway's supply costs rose 9% last fiscal year while surgical volume rose 2%, and the chief financial officer has asked every department for supply savings that do not reduce services. Second, the perioperative information system was upgraded in 2025, which for the first time allows item costs to be displayed on preference cards and in reports by surgeon and procedure. Third, the October audit gave the operating room its own numbers, which staff and surgeons have not seen before and which are harder to dismiss than national figures.

There are also reasons for caution that the project must respect. Surgeons may read a waste project as a criticism of their judgment, and circulating nurses fear being blamed if a held item is needed urgently. A project that cut waste by making cases slower or less safe would fail on its own terms. That is why the project question includes both a savings target and two conditions, no delays and no supply-related safety events, and why later stages will measure both.

The Project Question

Which combination of preference card cleanup, a hold-versus-open designation for high-cost items, and cost feedback to surgeons, supported by evidence and feasible at Ridgeway, would reduce the cost of opened-but-unused disposable supplies per case in the main operating room by at least a third within six months, without delaying cases or causing supply-related safety events?

The question is small enough for one term because it asks the project to choose, cost and plan the evaluation of specific changes, not to observe a year of results. Published work gives reason to expect that a reduction of that size is realistic: standardizing the preference card for one procedure reduced supply cost per case by 20% with no change in operative time (Avansino et al., 2013).

What Comes Next

The next stage settles the oversight question, improvement work or research, identifies each data source and who controls it, and plans the surgeon and staff interviews needed to understand why items are opened in advance.

References

Avansino, J. R., Goldin, A. B., Risley, R., Waldhausen, J. H. T., & Sawin, R. S. (2013). Standardization of operative equipment reduces cost. Journal of Pediatric Surgery, 48(9), 1843-1849. https://doi.org/10.1016/j.jpedsurg.2012.11.045

Chasseigne, V., Leguelinel-Blache, G., Nguyen, T. L., de Tayrac, R., Prudhomme, M., Kinowski, J. M., & Costa, P. (2018). Assessing the costs of disposable and reusable supplies wasted during surgeries. International Journal of Surgery, 53, 18-23. https://doi.org/10.1016/j.ijsu.2018.02.004

Farrelly, J. S., Clemons, C., Witkins, S., Hall, W., Christison-Lagay, E. R., Ozgediz, D. E., Cowles, R. A., Stitelman, D. H., & Caty, M. G. (2017). Surgical tray optimization as a simple means to decrease perioperative costs. Journal of Surgical Research, 220, 320-326. https://doi.org/10.1016/j.jss.2017.06.029

Zygourakis, C. C., Yoon, S., Valencia, V., Boscardin, C., Moriates, C., Gonzales, R., & Lawton, M. T. (2017). Operating room waste: Disposable supply utilization in neurosurgical procedures. Journal of Neurosurgery, 126(2), 620-625. https://doi.org/10.3171/2016.2.JNS152442