Hua Hin General Hospital (Thailand), serves as a referral center forcardiac patients in Prachuap Khiri Khan Province and neighboring areas. With a target of 2,000 coronary angiograms (CAG) annually, thehospital was committed to high-quality cardiac care.Our current process and costs : Patients undergoing CAGfollow a 3-day, 2-night admission process. Day 1 was admission forpre-procedure investigations (blood tests, ECG, X-rays).    Day 2 was catheterization procedure.  Day 3 was discharge, if no complicationsoccur.  The average cost was 8,000 THB (~$225 USD) per patient,including  6,000 THB (~$170 USD) for a3-day stay and 2,000 THB (~$56 USD) for investigations. These costs pose aburden to patients and the hospital.Resource Use and Environmental Concerns : Each procedureuses significant consumables, including 5 syringes, 500 mL of normal saline(injection and irrigation), and one red waste disposal bag. The resulting plasticmedical waste, taking up to 400 years to decompose, contributes substantiallyto environmental damage.Towards Cost-Effectiveness and Sustainability : Coronary angiography was a high-value procedure, but it generates high costs and significant medical waste. Hua Hin Hospital was exploring strategies to reduce costs, optimize resource use, and minimize waste, aligning healthcare services with environmental sustainability. These efforts reflect a commitment to delivering exceptional cardiac care while protecting the planet.

Development Activities (Process) : Advancing Efficiency and Sustainability in Coronary Angiogram Procedures. Communication and Team Engagement  : The catheterization lab team identified challenges and posed critical questions: WHY must the system be improved to reduce unnecessary medical material usage? And HOW can this be achieved ? This step fostered awareness and collaboration to find actionable solutions.System and Process Analysis : Using the LEAN methodology, the team analyzed the system, processes,and costs of each step in coronary angiogram (CAG) procedures to identify   inefficiencies or waste. The analysis focused on implementing the 7 R wastereduction approach for sustainable solutions.Reducing Waste in Preparation Steps  :  A significant change reduced unnecessary hospital admissions. Instead of admitting patients one day prior for pre-procedure preparation, a  new system was implemented. Patients under the Universal Health Coverage Scheme can undergo pre-procedure tests at their local or affiliated hospitals approximately 3 days in advance. Hua Hin Hospital beneficiaries can have tests conducted on the morning of admission day for streamlined preparation.  This reduced hospital stay, minimized costs,   and enhanced patient convenience.

Projected Outcomes Based on Annual CAG Target of 2,000 Cases1. Cost Savings for Pre-CATH InvestigationsBy reducing hospital-based Pre-CATH testing, Hua Hin Hospital can save up to 6,000 THB (~$170 USD) per case, potentially achieving 12 million THB (~$340,000 USD) in annual savings if the target of 2,000 CAG procedures is met.2. Reduction in Medical Waste : Syringes  The number of syringes used per procedure has been reduced from 5 to 2, saving 3 syringes per case. This change is projected to decrease medical plastic waste by 6,000 syringes annually for 2,000 CAG procedures.3. Reduction in Medical Waste : Saline BottlesThe volume of Normal Saline (Injection and Irrigation) has been reduced to 100 mL per type per procedure, significantly lowering the number of bottles used. This is expected to   reduce plastic bottle waste by 1,600 bottles per year for 2,000 CAG cases.4. Eliminating Red Waste BagsPreviously, one red waste bag was used per case. By repurposing large clear plastic covers (originally used for shielding lead curtains) for waste collection, the hospital will eliminate the use of 2,000 red waste bags annually for 2,000 procedures.

Hua Hin Hospital has implemented innovative strategies to optimize coronary angiogram (CAG) procedures, achieving significant cost savings and environmental benefits. By addressing inefficiencies in pre-procedure testing and material usage, the hospital has streamlined processes, reduced expenses, and minimized waste.Key Outcomes were 1. Cost Efficiency : Shifting Pre-CATH investigations to local or affiliated hospitals has the potential to save 6,000 THB (~$170 USD) per patient, amounting to 12 million THB (~$340,000 USD) annually with a target of 2,000 CAG cases.  2. Reduction in Syringe Use : Decreasing syringe use from  5 to 2 per case will eliminate 6,000 syringes annually, reducing plastic waste substantially.  3. Optimized Saline Usage : Lowering saline volumes to 100 mL per type has cut down the need for large saline bottles, resulting in a reduction of 1,600 plastic bottles annually.  4. Eliminating Red Waste Bags : Replacing red waste bags with reused clear plastic covers  for waste collection will save 2,000 bags per year, contributing to further waste reduction.  These changes not only enhance operational efficiency and reduce hospital expenses but also address the global challenge of medical waste. By significantly cutting down plastic and hazardous waste, Hua Hin Hospital demonstrates a commitment to environmental sustainability while maintaining high standards of patient care.Through innovative process improvements and a focus on sustainability, Hua Hin Hospital has set a benchmark in balancing high-quality medical care with cost-efficiency and environmental responsibility. These initiatives align with global goals for sustainable healthcare and reflect the hospital’s dedication to patient-centered care and environmental stewardship.