Background:
The healthcare sector generates 8.5% of greenhouse emissions in the United States, about 70-80% of which is from used instruments and supplies. GI endoscopy is the third largest contributor to healthcare-related waste with CO2 emission over 85,000 metric tons annually. Single-use tools are a major contributor to modifiable waste generation during GI endoscopy.
Through a quality improvement (QI) initiative, we aimed to reduce endoscopy waste by urging gastroenterologists to be mindful of tools used for polypectomies by avoiding use of multiple tools.

Methods:
(1) Baseline Data: We collected data regarding tools used during screening colonoscopies for 8 weeks before the intervention.
(2) Intervention: We discussed green endoscopy initiative by GI societies in North America during monthly journal club with gastroenterology faculty in open-ended forum. We also discussed green endoscopy initiative and potential strategies in day-to-day practice during monthly business meeting. Both meetings happened 3 days apart. To avoid Hawthorne effect, the project and details regarding data collection were not discussed with faculty.
(3) Post-Intervention Data: We collected data regarding tools used during screening colonoscopies for 8 weeks after the intervention.

Specific parameters compared included the number and type of instruments used during polypectomies. Patients with indications other than screening or surveillance colonoscopies were excluded. Differences between pre- and post-intervention use of accessories during screening colonoscopies were analyzed using pair-wise T-test and likelihood of using one tool over multiple tools were examined by odds ratios with level of significance p<0.05.

Results:
Over 14 weeks, 210 patients were included in the pre-intervention group and 112 in the post-intervention group. At baseline, 34% of colonoscopies required no intervention, 32% required one tool (either biopsy forceps or a snare) and in 33% required multiple tools. After the intervention, we observed significant increase in use of just one tool (17% increase, p<0.01) and decrease in use of multiple tools (16% decrease p<0.01) (Table 1, Figure 1). The odds of using single tool compared to multiple tools after intervention was 2.98 (95% CI 1.6-5.53), p=0.005.

Conclusion:
In this single-center QI study, we found a significant change in practice patterns favoring the use of single tool over multiple tools during colonoscopies after an environmentally conscious practice intervention was applied. We noted a significant increase in use of single tool over multiple tools, an overall decrease in multiple tool use and three times higher odds of using a single tool when compared to multiple tools during colonoscopies after an open-ended discussion regarding green endoscopy initiative. This intervention can be readily applied to reduce endoscopy-related waste.

Table 1: Results Table

Figure 1: Comparative depiction of the use of tools before and after intervention for screening/surveillance colonoscopies

Prateek Harne

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