Memorial Sloan Kettering saves big, is honored for achievements

The surgery department is sometimes referred to as the soul or epicenter of a hospital for a number of reasons: It can bring in up to 60% of a facility’s revenue, and the reputation of the operating room is often tied directly to the reputation of the hospital. 

At the same time, a typical OR can make up half of a hospital’s aggregate costs, produce 33% of a facility’s waste, consume more energy per square foot than any other area of the hospital, and anesthetic gases alone make up around 5% of an organization’s greenhouse gas footprint. 

All of this boils down to a department rich in opportunities to minimize impact and yield financial, environmental, and human health benefits.

Practice Greenhealth’s Greening the OR Leadership Award considers a range of programs and is designed to recognize the facility demonstrating the most success in reducing the environmental impact of its surgical suites.

For the second year in a row, Memorial Sloan Kettering Cancer Center’s efforts earned them this distinction – and saved themselves more than $614,400, avoided more than 33 tons of waste and saved over 1.8 million kilowatt hours.

Practice Greenhealth member Memorial Sloan Kettering Cancer Center saved $614,400 in a year by greening their operating rooms.

With more than 28 operating rooms at their Memorial Hospital location, treating high-acuity patients, their continued commitment to innovate and drive environmental stewardship is evident through programs focusing on waste reduction, energy conservation, clinician and nursing leadership, and supply chain collaboration.

Memorial Sloan Kettering (MSK) has developed dedicated task forces to focus on department-specific goals and programs. The hospital’s Greening the OR committee is made up of OR and anesthesia staff, nurses, surgeons, and staff from OR materials management, perioperative, radiology, facilities management, environmental services, ambulatory care, sustainability, and hospital administration. This broad representation of stakeholders has helped to foster leadership and a culture that encourages staff to seek opportunities to innovate and re-think how things are done.

Memorial Sloan Kettering’s OR materials management and nursing staff along with vendors reviewed 100% of OR packs/kits in 2018 in order to enact efficiencies through product substitutions and material reduction. Out of the 55 kits reviewed in 2018, 25 items were removed for an estimated savings of $60,000 annually. 

The Greening the OR committee focused their staff education efforts on waste segregation and recycling and is establishing a pilot process to evaluate the collection, storage, logistics, quality, and market resale of blue wrap to set the stage for a blue wrap collection and recycling program. The team is also evaluating workflows and is looking to leverage vendor relationships to assist with logistics.

The use of fluid management systems across all main campus procedures helped the hospital avoid spending $50,000 to dispose 125 tons of fluid waste as regulated medical waste.

When possible, the OR staff choose reusable devices over disposables. The patient population at MSK is extremely vulnerable with highly compromised immune systems, so working with infection control is critical to these programs being successful while maintaining patient safety.

When reusables aren’t feasible, reprocessing medical devices is often a win-win for facilities in terms of waste and financial savings, but contracts can be challenging. Through concerted efforts and vendor partnerships, MSK’s procurement and sourcing team established a new reprocessing contract enabling them to collect and purchase more supplies, diverting a higher volume from the waste stream.

In 2018, the hospital’s Greening the OR committee convened a group of nursing, perioperative, OR tech, environmental services, anesthesia, and surgical staff to formulate MSK's "OR Energy Efficiency Checklist." The checklist provides an expanded set list of equipment and machines that should be shut down nightly to maximize energy savings in operating rooms and highlights direct departmental roles and responsibilities for the nightly shutdown practices.

The hospital started evaluations in 2015 with several different vendors to pilot LED boom lights in the ORs that did not utilize LED technology, while also evaluating new audiovisual systems to be paired with the LED upgrade. The pilot process provided surgeons the opportunity to evaluate the effect of a switch in lighting technology on color recognition as well as shadows to ensure there would not be any impact on patient outcomes or surgeon processes during critical procedures.

Throughout 2016 and 2017, all 28 operating rooms at MSK were upgraded to LED boom lights, saving a total of 46,124 kilowatt hours and $7,379 in associated electrical costs annually, while improving lighting quality and temperature comfort for surgical staff.

When a patient is in the OR, the space has strict heating, cooling, humidity, pressure, and temperature requirements, as well as specific needs for lighting and patient monitoring equipment. During off-hours, when the OR is typically unoccupied and unused, there is potential to save energy. For instance, the number of air changes per hour can be reduced, temperature and humidity can fluctuate, and lights and equipment can be powered down/put on standby mode. 

Memorial Sloan Kettering used occupancy sensors and demand-based ventilation in all 28 operating rooms to maximize the number of hours when air changes per hour could be set back during unoccupied times. The project was initiated by a plant operations supervisor, who took a two-phased approach. Initially, the set back lowered air change rates from 25 air changes per hour to 12 per hour. After a thorough analysis, unoccupied air changes in the ORs were then lowered to six air changes per hour. Fully maximizing the system’s ability to set back down to six air changes per hour when unoccupied helps the organization save more than 1.7 million kilowatt hours, reduce 39,740 million pounds of steam, yielding $284,056 in energy savings while having no impact on the functioning of the OR.

Using occupancy sensors and demand-based ventilation in their operating rooms helps Memorial Sloan Kettering Cancer Center save more than 1.7 million kilowatt hours, yielding $284,056 in energy savings while having no impact on the functioning of the OR.

Sustainability staff also included all OR computers in the institutional computer shutdown program, intended to utilize the computers’ built-in schedulers to automatically power down computers overnight and when not in use. Some clinical computers are exempt from the program to ensure casework and reviews are never interrupted. Throughout 2018, an average of 91% of the more than 315 non-exempt OR computers were automatically shutting down at night, providing consistent energy and related cost savings of around $8,100 annually.

Memorial Sloan Kettering’s sustainability staff, the director of nurse anesthesia services, and administrator for anesthesiology-critical care presented to the Greening the OR committee, offering evidence, strategies, and case studies about the climate impacts and cost savings of anesthetic gas choices. The team is focused on expanding these efforts in 2019 through new physician and clinical champions on the Greening the OR committee.  

Reducing the greenhouse gas emissions from anesthesia may be a small piece of the puzzle, but it all adds up, and will help MSK achieve their goal of 50% reduction in GHG emissions by 2025, which is part of the New York City Carbon Challenge. 

Learn the techniques that aided Memorial Sloan Kettering's success