UCSF Sustainability Stories

Deborah Fleischer, Green Impact, November 2016

Reducing Waste in the ORs:  Spotlight on Dr. Corinna Zygourakis

Dr. Corinna Zygourakis, a resident physician in the neurosurgery program at UCSF, was recently awarded the UCSF 2016 Sustainability Award in the student category. She was recognized for her leadership on the Caring Wisely program. During her residency training, she developed an interest in healthcare costs, surgical waste, and sustainability. She developed and led a robust program that provided feedback to UCSF leadership and her surgical colleagues about surgical supply costs and related waste. Remarkably, she introduced this program during a clinical year of her residency, somehow balancing the intense demands of being a clinical neurosurgery resident and running a multidisciplinary project team. Through education, research, and outreach Dr. Zygourakis has ignited a cultural change amongst surgeons. Her programs (OR SCORE and OR Waste Project), which focus on reducing operating room (OR) waste, have made a real impact—conservatively saving UCSF $800,000 to date and significantly reducing waste.

We had the opportunity to ask Dr. Zygourakis a few questions about sustainability at UCSF.

1.  What sparked your interested in sustainability personally?

Last summer (July 2015), I participated in a neurosurgical mission trip to Guadalajara, Mexico, called Mission:BRAIN led by one of our attending neurosurgeons Dr. Michael Lawton. The trip was an amazing experience, but one of the things that really shocked me was how differently the Mexican doctors and nurses treat supplies in the operating room. At the end of a surgical case in Mexico, the nurse’s sterile field was totally clean/empty—there were no supplies that were opened, but unused. If we needed additional sutures as we were closing the wound, the nurses would actually leave the room to get sutures and then open it up onto our field. This was shockingly different from our cases at UCSF, where I had gotten used to seeing so many supplies left over at the end of every case during my first four years of neurosurgical residency.

This got me thinking: how much of what we open do we really need when we operate in a resource-rich setting like UCSF? As soon as we returned from Mexico, Dr. Lawton and I started a project to document waste in the Parnassus operating rooms. We found that unfortunately, there is a very significant amount of waste in our ORs at UCSF (approximately $650 per neurosurgical case). We are now working hard with surgeons and nurses to educate them and come up with the best ways to reduce this OR waste.

2.  How do you see the connection between health care and sustainability?

I think that sustainability is a vital part of healthcare. We all know that U.S. healthcare costs are extraordinarily high and rising, and I firmly believe as physicians (and citizens) that bringing down healthcare costs is part of our responsibility. This is why I have devoted my research efforts to defining the variation in costs for neurosurgical care (using both UCSF data and national databases) and better understanding the drivers of high cost for surgical procedures. Inherent in this type of work is minimizing variation and reducing waste to ensure that we can provide the highest quality surgical care to the greatest number of patients possible.

3.  What inspired you to get involved in sustainability at UCSF?

In 2014, I received a Caring Wisely grant to lead a project entitled “OR SCORE: OR Surgical Cost Reduction Project”.  I did not know when I got the grant how lucky I was to be working with such an amazing team at Caring Wisely, including the director Chris Moriates, data analyst Victoria Valencia, and Chief Innovation Officer Ralph Gonzales. The Caring Wisely team provided analytics support, statistics and EPIC expertise, QI intervention design advice, and funding for the project, in addition to serving as a liaison with other departments and UCSF administration. Our team created scorecards for individual surgeons to show them how much their surgeries cost over time and in comparison to their peers. We distributed these scorecards to OHNS, orthopedic, and neurosurgeons every month in 2015 and demonstrated $800,000 in savings with this cost feedback intervention. Working on this multi-disciplinary team project showed me how challenging, yet rewarding, it is to implement interventions at the hospital level that involve physicians, nurses, and administrators. It inspired me to get involved in other projects like this at UCSF because I realized that our work and efforts can actually make a difference!

4.  What aspect of sustainability at UCSF do you find most exciting?  Most challenging?

As a neurosurgeon, I love a challenge. So the most exciting aspects of healthcare sustainability for me are its challenges! Reducing cost and waste in healthcare is particularly challenging because there is still very limited visibility into this area. We are hoping that projects like OR SCORE and the OR Waste project help shed some light on this for everyone working at UCSF- physicians, nurses, and administrators alike!

5.  What one call to action would you ask of the UCSF community?

I would ask that all of us physicians start paying more attention to the resources we use to take care of our patients, whether it’s the laboratory tests we order as a primary care doctor, the imaging we order as a specialist, or the supplies we use in the operating room as a surgeon. We have not been trained to think about cost, but we should start considering how much each of our interventions/supplies cost, given that we are often the most appropriate people to determine whether or not any given intervention is truly necessary for our patients. I am fully aware of how difficult it is to do this in our already overly busy work lives, but I do believe that we have a responsibility to do this so that we can keep overall healthcare costs down and continue to provide health care to the greatest number of patients possible.

To learn more, you can refer to a recent paper on OR Waste that was published in the Journal of Neurosurgery:  Operating room waste: disposable supply utilization in neurosurgical procedures.