Interventional cardiology

Five ways cardiologists can reduce waste in the cath lab

Cardiologists have been urged to take a leadership role in improving sustainability in the health system, with experts arguing cardiac catheter laboratories are major culprits when it comes to pollution.

On the positive side, they say there is significant scope for the specialty to enact reforms, given the volume of waste generated by the sheer numbers of cardiac procedures performed every year.

In a recent journal article, an Australian and international team point out the local health care sector contributes 7% of national carbon emissions – equivalent to that generated by all activities in the state of South Australia.

Much of this is beyond the purview of cardiology, with the entire health system going through ever-increasing amounts of resources, particularly with the move towards disposable and single-use items.

“The cardiac cath lab (CCL) has not been immune to this trend with standard practice employing single use items including drapes, gowns, gloves, plastic bowls, syringes, manifolds, catheters and angioplasty balloons as well as the single use plastic many of these items are packaged in,” they wrote in Heart, Lung and Circulation (link here).

“Additionally, most CCL have pre-made ‘cath lab packs’ and it is not uncommon to find items in these packs that are never used.”

Most of these items—both used and unused—are either incinerated or destined for landfill, meaning “it is not difficult to comprehend that with over one million cardiac catheterisation procedures performed annually in the US alone, that this clearly results in a significant environmental footprint globally,” they added.

With that in mind, the team put together a list of five strategies they say can be adopted by anyone involved in a CCL to reduce waste and make their facility more sustainable.

1. Acknowledge the issue
They say the first step is to acknowledge the amount of waste in the CCL and take ownership of the problem. This means education and empowering teams to reduce rubbish.
Another idea put forward is to promote collaboration and even “healthy competition” between institutions to see which can make the biggest difference.

2. Seek appropriate non-invasive investigations
The push to reduce unnecessary care and intervene only when the benefits are clear is nothing new, but the planet would be another potential beneficiary, the authors say.

They point out invasive angiography is still commonly used early in the diagnostic pathway in patients with suspected coronary disease, despite the availability of other, less resource-intensive investigations.

3. “The Five R-Concept”: Reduce, Reuse, Recycle, Rethink and Research
The authors call for a ‘lean’ mindset in the CCL, saying the five ‘Rs’ are a useful framework for improving use of resources.

Practical examples could include demanding the removal of rarely-used items from cath lab packs and cutting down on excess packaging.

“Currently, angioplasty balloons come packaged in cardboard boxes and encased within plastic hard shells with balloon packs also including paper instructions on usage and balloon pressures,” they write.

“It is clear significant improvements can be made, if sought.”

Other ideas include re-using supplies where possible, encouraging recycling.

4. Focus on implementation
A coherent and clear waste reduction policy is important, but ensuring buy-in across the organisation is vital, the authors say.

They also call for the use of sophisticated management tools to evaluate each CCL’s performance.

5. Monitoring and quality improvement
Comprehensive data is needed to establish baseline carbon footprints, as well as to evaluate the effectiveness of any reforms.

“A tracking system would enable identification of major sources of emissions and inefficiencies which would allow more effective resource allocation in efforts to decarbonise the CCL,” they write.

“Data from the system should be used for quality improvement, strategy evaluation and providing objective feedback to clinical teams.”

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