MEDICINE@BROWN: Waste Not

Emergency departments at hospitals in Rhode Island are potentially disposing of tons of unopened medical supplies, creating significant financial and environmental waste, researchers found.

The findings, published in the American Journal of Emergency Medicine in September,  tallied several weeks’ worth of waste collections at The Miriam and Kent hospitals. Katelyn Moretti F’20, MD, MS, assistant professor of emergency medicine, and Kyle Denison Martin F’19, DO, MPH, assistant professor of emergency medicine, clinician educator, led the study, partly out of their own interests on the impacts of climate change in health.

“The health care industry specifically is responsible for 8.5% of all emissions in the US, so we play a big role in carbon emissions nationally and worldwide,” Moretti says. She says Rhode Island in particular lags behind other states in addressing such waste, so further education and insight are needed.

Martin says emergency providers have an up-close view of how consumption and waste directly contribute to emissions. Daniel Hu '21 MD'25, Marina Hahn MD'25, and David Dorfman MD'25 collected over 300 pounds of unopened supplies from bins throughout each emergency department. Approximately 45 percent of this waste was composed of components from intubation kits, and purchasing costs across both sites yielded a yearly extrapolated value of over $150,000 and 5.79 tons of carbon dioxide equivalent, which is comparable to over 5,800 pounds of coal burned.

They were surprised by the high number of IV start kit and intubation kit components, like airways, tubing, and syringes, that reached the bins. There were also a large number of items from IV start kits. Waste in general can be exacerbated by understaffing, and such waste from IV start kits would be collected by nursing staff during a “clean sweep” prior to environmental services performing a thorough cleaning. However, such procedures become a lower priority when nurses are pressed for time.

“If you’re understaffed, your emergency department is busy enough,” Martin says. “And when environmental services come through, they might not have the ability or the knowledge to restock items.”

Moretti says their students were vital to completing the study. Dorfman helped craft a presentation for Brown University Health to advocate for greater scrutiny over purchasing habits. Hahn, Hu, and Dorfman were stunned at the carbon footprint; they filled an entire conference room with waste that needed days of sorting and calculations.

“It gave me more insight into the administrative hoops you have to jump through to get information about purchasing,” Hahn says. She hopes the study will help hospitals adjust purchasing that result in fewer wasted items and cost savings.

Hu found it daunting early on as a first-year medical student when it came to learning the intricacies of hospital administrations. "I haven't spent that much time in a hospital, nor have I ever worked in one, so just being able to talk to all these different departments and know what's the best way of communicating with them was super helpful," he said. He also gained greater confidence in approaching similar analyses in ophthalmology as he wraps up his fourth year.

“It was cool that we saw how you could advocate for change from within the system,” Dorfman adds. “We were even able to disseminate our findings to the wider community with a lot of interest in them, and it was rewarding to see that.”