title: Preventable drug waste among anesthesia providers: opportunities for efficiency.
abstract: BACKGROUND
  Health care service bundling experiments at the state and regional levels have showed reduced costs by providing a single lump-sum reimbursement for anesthesia services, surgery, and postoperative care. Potential for cost savings related to the provision of anesthesia care has the potential to significantly impact sustainability. This study defines and quantifies routine and preventable anesthetic drug waste and the patient, procedure, and anesthesia provider characteristics associated with increased waste.
  
  
  METHODS
  Over a 12-month period, the type and quantity of clean drugs prepared by the anesthesia team for the first case of the day were recorded. The amount of each drug administered was obtained from the computerized anesthesia record, and data were analyzed to determine the incidence and cost of routine and preventable drug waste. The monthly and yearly cost of preventable waste, including the cost of pharmacy tech labor and materials where applicable, was estimated based on surgical case volume at the study institution. All analyses were performed using SAS software v9.2.
  
  
  RESULTS
  Anesthetic drugs prepared for 543 separate surgical cases were observed. Less than 20% of cases generated routine waste. Preventable waste was generated most frequently for ephedrine (59.5% of cases), succinylcholine (33.7%), and lidocaine (25.1%), and least frequently for ondansetron (1.3%), phenylephrine (2.6%), and dexamethasone (2.8%). The estimated yearly cost of preventable anesthetic drug waste was $185,250.
  
  
  CONCLUSIONS
  Significant potential savings with little impact on clinically significant availability may be achieved through the use of prefilled syringes for some commonly used anesthetic drugs. An intelligently implemented switch to prefilled syringes for select drugs is a potential cost saving measure, but savings might be diminished by disposal of prefilled syringes when they expire, hidden costs in the hospital pharmacy, and inability to supply some medications in prefilled syringes due to stability or manufacturing issues.
authors.affiliation: Oregon Anesthesiology Group, Portland, OR, USA. Electronic address: catcheson@oagpcgroups.com.
authors.forename: Carrie Leigh Hamby
authors.initials: CL
authors.lastname: Atcheson
authors.affiliation: Department of Health Policy and Evidence, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: john.spivack@mountsinai.org.
authors.forename: John
authors.initials: J
authors.lastname: Spivack
authors.affiliation: Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: bob.williams@mountsinai.org.
authors.forename: Robert
authors.initials: R
authors.lastname: Williams
authors.affiliation: Departments of Anesthesiology and Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: ethan.bryson@mountsinai.org.
authors.forename: Ethan O
authors.initials: EO
authors.lastname: Bryson
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000191:economics*; D000776:Anesthesiology / Q000191:economics*; D000777:Anesthetics / Q000008:administration & dosage* / Q000191:economics; D017046:Cost Savings; D004526:Efficiency; D006801:Humans; D008875:Middle Aged; D013594:Syringes
chemical_list: D000777:Anesthetics
keywords: Anesthesia; Anesthesia drugs; Cost containment; Drug waste; Efficiency; Reducing waste