HA 695 Unit 4 current state analysis example

Open Everything on the Card: A Current State Analysis of Supply Waste in Ridgeway's Operating Room, From the $182 Baseline to a $543,000 Gap

Student Name

Health Care Administration, Herzing University

HA 695: Graduate Capstone Project

Instructor Name

February 5, 2026

Open Everything on the Card: A Current State Analysis of Supply Waste in Ridgeway's Operating Room, From the $182 Baseline to a $543,000 Gap

Baseline, With Its Method

Baseline measure: dollars of disposables opened and discarded without use, per case. Value: $182. Period: October 6 to October 31, 2025. Source: direct observation of 120 cases across all nine main operating rooms by two perioperative nurse educators, who logged each disposable item as it was opened and then noted, at closing, which ones had never been touched; item costs from the supply chain catalog at October prices. Method for the annual figure: waste per case was calculated for each of the six largest services and weighted by each service's fiscal 2025 case volume. The weighted average is $182 per case, the same as the audit average, and the annual total is about $1.62 million.

Two limits apply. Observation may have changed behavior, which would make the baseline an underestimate; the educators reported that staff seemed to forget them after the first hour. And 120 cases is a small sample for services with few cases in the window, so the service figures below carry more uncertainty than the total.

Where the Waste Is

By service, weighted to annual volume:

Checking the Baseline Against a Second Source

Because the baseline rests on one month of observation, it was checked against the materials management system, which records supplies issued to each case and supplies returned unopened. For the same October cases, the system showed an average of $1,540 in disposables issued per case, matching the audit, and returns averaging only $31 per case. The system cannot distinguish items used from items opened and discarded, so it cannot measure waste directly, but it confirms two things: the audit's supply totals are consistent with the hospital's records, and very little of what is picked is returned. The check also found that 9% of issued items were not on any preference card, meaning they were requested during the case; those items are rarely wasted, because they are opened only when asked for. That supports the idea behind a hold-versus-open designation: items retrieved on request are opened when needed, while items opened in advance are the ones discarded.

Concentration

Two services, orthopedics and spine, account for 62% of the waste. Within them, 12 surgeons account for 61% of the hospital's total. Fifteen items account for 58% of wasted cost, led by hemostatic agents, single-use energy device handpieces, specialty sutures and pulsed irrigation systems. Most wasted items are inexpensive, but a few costly items opened just in case drive most of the dollars. This matches published findings that waste varies more by surgeon and case type than by case length (Zygourakis et al., 2017b), and it means that a small number of card reviews and item decisions can move most of the total.

The Current Process, as People Actually Do It

The day before surgery, between 7 and 11 p.m., a supply technician picks each case cart from the surgeon's preference card. On the morning of surgery, the circulating nurse and surgical technologist open onto the sterile field every item on the card, before the patient enters the room. Items not on the card are retrieved from the core during the case if the surgeon asks. After the case, opened items are discarded whether used or not, because sterility cannot be restored, and unopened items on the cart are supposed to be returned to stock; the supply chain analyst estimates that about 40% are.

The written policy says only that the card should be followed. The practice is stricter: staff describe an unwritten rule to open everything on the card, because an item that is not ready when a surgeon asks for it causes a delay and, sometimes, criticism in front of the team. Two workarounds exist that no document mentions. Several experienced surgical technologists keep personal notes of items particular surgeons never use and quietly leave those unopened, which reduces waste in their rooms but depends on who is scrubbed. And some surgeons, asked about their cards, said they were built by a nurse years ago and never reviewed; they assumed someone else maintained them. Updating a card requires a request to the information systems analyst, with a current queue of about three weeks, so small corrections are rarely made.

The Gap

The evidence review found that preference card standardization reduced supply cost per case by a fifth in one study (Avansino et al., 2013), and that cost feedback with an incentive reduced supply cost by about 10% after adjustment in another (Zygourakis et al., 2017a). A reduction of one-third in waste, which is a smaller target than total supply cost, is therefore an evidence-supported level for a combined approach aimed at the waste specifically. One-third below $182 is about $121 per case. The gap is about $61 per case, or about $543,000 a year at current volume.

The gap can also be stated in items. At current waste levels, the audit implies that about 58,000 disposable items a year are opened and discarded unused. Reducing that number also reduces restocking work and the disposal volume that environmental services handles, benefits the business case will note but not count.

Constraints

Staff time: reviewing a card with a surgeon takes about 20 minutes, and the ten highest-waste procedures for the 12 highest-waste surgeons involve about 80 cards. Information systems: card changes and cost display depend on one analyst with a three-week queue. Surgeon independence: most Ridgeway surgeons are not employed and cannot be required to review cards; participation depends on the chair of surgery and on showing surgeons their own data. Sterility and safety: nothing that is needed urgently, such as hemostatic agents in a bleeding patient, can be held in a way that delays access; any hold list must be reviewed with surgeons and nursing. Contracts: some items are committed under group purchasing agreements, so reducing use lowers spending but does not change unit prices.

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

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