Monday, July 15, 2024

Greenhouse Gas Reduction: Hospitals Take Steps to Minimize Environmental Impact from Patient Care

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It’s increasingly acknowledged that the healthcare sector significantly contributes to greenhouse gas emissions, making up nearly 9% of the U.S. However, the impact of common substances used in patient care is less known, such as anesthetic gases and inhalers.

Examining the science reveals an irony: the same mechanisms used to ensure patient safety during procedures or asthma attacks harm the environment. For instance, desflurane, a common inhaled anesthetic, has heat-trapping properties hundreds to thousands of times greater than carbon dioxide. Similarly, nitrous oxide, a sedative used in surgeries, has a warming potential 273 times that of carbon dioxide and damages the ozone layer, which protects us from harmful solar radiation. Even metered-dose inhalers, containing small amounts of hydrofluorocarbon gas, significantly contribute to emissions.

Last month, a group of safety net hospitals and municipal health departments launched a 10-month collaborative effort to test decarbonization interventions and measure their outcomes. Led by the Institute for Healthcare Improvement (IHI), the initiative involves sustainability professionals, clinicians, and healthcare leaders across six states. Each organization will choose an improvement project and receive support from experts and peers.

Greenhouse Gas Reduction Efforts by Safety Net Hospitals Lead to Innovative Solutions

“For safety net hospitals operating on tight margins and serving populations disproportionately affected by climate change, reducing carbon emissions can enhance their mission, strategy, and financial health,” the IHI stated in its request for applications. The previous IHI decarbonization cohort, which concluded in December 2023, saw over a dozen organizations participate in 16 quality improvement projects. More than half reported reductions in waste or anesthetic gas purchases. Several sites decommissioned central nitrous oxide systems and eliminated desflurane from their operating rooms. Participants shared their achievements with Fierce Healthcare.

Nitrous oxide, commonly used in dentistry, can be stored in large centralized tanks or portable cylinders. While centralized systems require less frequent tank changes, hospitals worldwide have found that 75% to 95% of their nitrous oxide leaks out through the central piping, wasting resources and polluting the atmosphere. Addressing this issue was a goal for Northwell Health, which joined the last IHI decarbonization cohort. With over 800 ambulatory sites and 20 hospitals, figuring out gas procurement and usage was a significant challenge. Teresa Murray Amato, M.D., VP of Clinical Sustainability and Resource Stewardship, started by seeking allies interested in sustainability.

Northwell tested if anesthesiologists could manage with only portable tanks for three days, finding that gas usage was infrequent. This data led to the decision to decommission centralized nitrous oxide systems without impacting clinical practice. The success of this project is now inspiring similar initiatives, aiming to eliminate almost all central tanks by the end of 2024.

Each puff of a metered-dose inhaler uses hydrofluorocarbon gas, a potent greenhouse gas with a warming potential thousands of times that of carbon dioxide. Despite their small size, 144 million inhalers were prescribed in the U.S. in 2020, with three-quarters containing this gas. In England, these inhalers account for 3% of total National Health Service carbon emissions, equivalent to the emissions from all NHS electricity usage.

Greenhouse Gas

Efforts to Reduce Inhaler Emissions and Integrate Climate Priorities in Healthcare

Gregg Furie, M.D., medical director for climate and sustainability at Brigham and Women’s Hospital, highlighted the substantial environmental impact of inhalers. Alternatives like dry powder and soft mist inhalers exist, and Mass General Brigham aimed to reduce the use of metered-dose inhalers through the IHI collaborative. The goal was to raise awareness and shift prescriptions to more environmentally friendly options. While data on the project’s outcomes is not yet available, the initiative has created momentum for change, driven by increased scrutiny of patent processes and high prescription costs at the federal level. Efforts to develop inhalers with lower warming potential are ongoing, with advocates urging the FDA to prioritize sustainability in drug evaluations.

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The collaboration’s idea originated from the Agency for Healthcare Research and Quality commissioning IHI to develop a decarbonization primer. IHI, along with the National Academy of Medicine and Health Care Without Harm, created resources and a collaborative framework to inspire leader engagement and build will across departments.

Organizations participating in the collaborative successfully advocated for additional sustainability hires and integrated clinical decarbonization metrics into their key performance indicators. The growing acceptance of integrating climate priorities into broader system strategies is advancing local frontline climate work with clinician leadership. The collaborative aims to center climate as a broader priority, enhancing healthcare sustainability efforts and contributing to a healthier environment for all.


Resource: Fierce Healthcare, June 25, 2024

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