HA 695 Unit 3 organizational evidence review example

What Reduces Opened-but-Unused Supplies? An Evidence Review Organized by Finding, With Each Finding Tested Against Ridgeway's Operating Room

Student Name

Health Care Administration, Herzing University

HA 695: Graduate Capstone Project

Instructor Name

January 29, 2026

What Reduces Opened-but-Unused Supplies? An Evidence Review Organized by Finding, With Each Finding Tested Against Ridgeway's Operating Room

The Search

Databases: PubMed and CINAHL. Terms: ("preference card" OR "surgical waste" OR "operating room waste" OR "unused supplies" OR "supply cost" OR "tray optimization" OR "surgeon scorecard") combined with ("operating room" OR surgery OR surgical). Years: 2010 through 2025. Language: English. Included: studies in hospital operating rooms that measured the amount or cost of disposable supply use or waste, or tested an intervention against a measured baseline. Excluded: studies limited to implants, reprocessing of single-use devices, anesthesia drugs, or environmental impact without cost or quantity measures; opinion pieces and trade articles. The search returned 214 records; after title and abstract screening, 23 were read in full and 9 were kept. The findings below draw most on six of them. One older study of surgeons' cost knowledge was added by hand from a reference list because it bears directly on the feedback question.

Finding 1: Waste Is Real, Large in Some Specialties, and Varies by Surgeon More Than by Case Length

In direct observation of 58 neurosurgical procedures, supplies opened and left unused cost an average of $653 a case, a little over an eighth of all surgical supply spending, and the surgeon and case category, not case length or the surgeon's years in practice, predicted the share wasted (Zygourakis et al., 2017b). A French study of 55 digestive, urologic and gynecologic procedures found a much smaller median waste per case but found waste reaching as much as 20.1% of allocated supply cost in some procedures (Chasseigne et al., 2018). The studies disagree on magnitude, and the disagreement is informative: waste is concentrated in specialties that use many costly disposables, and it tracks individual preference.

Applicability. Ridgeway's audit found $182 per case across mixed services, with spine and orthopedics highest, which fits the pattern: a community hospital's average sits between a neurosurgical department and routine general surgery. The finding that surgeon predicts waste supports a surgeon-by-surgeon approach rather than a blanket rule.

Finding 2: Standardizing Preference Cards Cuts Supply Cost Without Harming Outcomes

At a children's hospital, a standardized preference card for laparoscopic appendectomy lowered per-case supply spending by a fifth, with no significant change in operative time, time in the room or length of stay (Avansino et al., 2013). Tray optimization, the parallel intervention for reusable instruments, removed 10% to over 90% of instruments from trays across five surgical sections with few requests to restore them (Farrelly et al., 2017).

Applicability. Both studies worked procedure by procedure with surgeon agreement, in academic pediatric settings with a small number of surgeons per service. Ridgeway's surgeons are mostly independent, in adult practice, with more variety per procedure. That argues for starting with the ten highest-volume procedures and seeking consensus cards only where surgeons already practice similarly, rather than imposing one card per procedure.

Finding 3: Surgeons Rarely Know Costs, and Cost Feedback Changes Behavior Modestly

In a survey of 503 orthopedic physicians at seven academic centers, attending surgeons estimated the cost of common devices within 20% of the true figure only 21% of the time, while more than 80% said cost should matter in device selection (Okike et al., 2014). In a controlled study across one health system, surgeons who received monthly scorecards comparing their median supply cost per procedure with their own baseline and with peers, combined with a small departmental incentive, reduced median supply cost per case by 6.5% while the comparison group's rose 7.4%; patient outcomes were equivalent or better (Zygourakis et al., 2017a).

Applicability. The scorecard study's effect is real but modest, and it came with a financial incentive Ridgeway may not offer. The survey concerned implants, which this project excludes, but its central point, that surgeons do not see costs, applies equally to disposables. Feedback is therefore worth including as one part of a combined approach, not as the main lever.

Finding 4: Holding Items Unopened Is Recommended but Untested

Several of the included studies recommend clarifying which supplies should be opened in advance and which kept available in the room unopened (Zygourakis et al., 2017b). None tested that change on its own or measured whether it caused delays. This is the project's largest evidence gap and its most direct operational question, because Ridgeway staff open items in advance precisely to avoid delays.

Strength of the Evidence, Plainly Stated

The evidence is consistent in direction but modest in design. Every study is from a single hospital or health system; most are before-and-after comparisons without a control group; one has a concurrent comparison group; none is randomized. Sample sizes for observation studies are small, 55 to 120 cases. The findings are credible enough to guide what Ridgeway tries, but not strong enough to predict the size of Ridgeway's result, which is why the project must measure its own.

How the Findings Shape the Project

Taken together, the findings point to a combined approach rather than any single change. Card cleanup, the intervention with the clearest effect, addresses the 38% of Ridgeway's cards that have not been reviewed in two years and the 214 that belong to surgeons who have left. Cost feedback addresses the knowledge gap the survey found, and while its effect is modest, it costs little once the information system can display item costs. A hold-versus-open designation addresses the specific behavior Ridgeway staff described, opening items in advance to avoid delays, but because no study tested it, it must be introduced as a small test with delays measured from the first day. The evidence also suggests an order: begin with the services and surgeons whose waste is highest, since that is where the published variation is greatest and where a small number of card reviews will move the total most.

What the Evidence Does Not Settle

The review leaves the project with three open questions. Whether a hold-versus-open designation reduces waste without causing delays, which no included study measured. Whether gains last beyond the first year; most studies followed results for a year or less. And whether card cleanup works in a community hospital where most surgeons are not employed by the organization and have no departmental incentive. The current state analysis and the evaluation plan are designed with those gaps in view.

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

Okike, K., O'Toole, R. V., Pollak, A. N., Bishop, J. A., McAndrew, C. M., Mehta, S., Cross, W. W., III, Garrigues, G. E., Harris, M. B., & Lebrun, C. T. (2014). Survey finds few orthopedic surgeons know the costs of the devices they implant. Health Affairs, 33(1), 103-109. https://doi.org/10.1377/hlthaff.2013.0453

Zygourakis, C. C., Valencia, V., Moriates, C., Boscardin, C. K., Catschegn, S., Rajkomar, A., Bozic, K. J., Soo Hoo, K., Goldberg, A. N., Pitts, L., Lawton, M. T., Dudley, R. A., & Gonzales, R. (2017a). Association between surgeon scorecard use and operating room costs. JAMA Surgery, 152(3), 284-291. https://doi.org/10.1001/jamasurg.2016.4674

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