Reducing Waste: Instrument Recycling in the Emergency Department

Emergency medicine (EM) residency programs are required to teach quality improvement (QI), yet few adopt a sustainability lens to QI despite broad recognition of the importance of climate sustainability in healthcare. To address this gap, some programs have piloted innovative approaches such as sustainability QI electives or projects, although evidence of their effectiveness remains limited.

We designed and implemented a sustainability QI initiative to recycle used instruments from three bedside procedure kits (laceration repair, incision and drainage, chest tube placement) commonly used in the emergency department to reduce waste. Our goal was to describe the effectiveness of a financial intervention on instrument recycling by comparing the differences in recycling rates between the baseline and incentive periods using a quasi-Poisson regression analysis.

At the end of the first year of instrument recycling, the recycling rate was 9%. Providing a financial incentive to residents over a two-year period significantly increased the recycling rate to a mean of 24% (standard deviation 13), with a rate ratio of 3.03 (95% CI 1.57-5.85), P < .001. While the residents did not meet their recycling target of 50% to receive the incentive payment, their overall recycling rate increased.

Providing a financial incentive to residents for recycling efforts was modestly successful in encouraging residents to participate in an instrument recycling initiative. Motivating busy clinicians to engage in sustainable practice is challenging; projects that prioritize systems-level changes may be more effective than those that require changes in individual clinical practices.