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Pratt B. Defending and Defining Environmental Responsibilities for the Health Research Sector. SCIENCE AND ENGINEERING ETHICS 2024; 30:25. [PMID: 38842627 PMCID: PMC11156718 DOI: 10.1007/s11948-024-00487-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 04/30/2024] [Indexed: 06/07/2024]
Abstract
Six planetary boundaries have already been exceeded, including climate change, loss of biodiversity, chemical pollution, and land-system change. The health research sector contributes to the environmental crisis we are facing, though to a lesser extent than healthcare or agriculture sectors. It could take steps to reduce its environmental impact but generally has not done so, even as the planetary emergency worsens. So far, the normative case for why the health research sector should rectify that failure has not been made. This paper argues strong philosophical grounds, derived from theories of health and social justice, exist to support the claim that the sector has a duty to avoid or minimise causing or contributing to ecological harms that threaten human health or worsen health inequity. The paper next develops ideas about the duty's content, explaining why it should entail more than reducing carbon emissions, and considers what limits might be placed on the duty.
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Affiliation(s)
- Bridget Pratt
- Queensland Bioethics Centre, Australian Catholic University, Brisbane, Australia.
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Benedetto V, Ferrè F, Nuti S. Including environmental and social sustainability in the planning process of healthcare services: A case study of cancer screening programs in an inner area in Italy. Health Policy 2024; 144:105074. [PMID: 38652936 DOI: 10.1016/j.healthpol.2024.105074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/20/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
Healthcare systems plan their activities to achieve efficiency and effectiveness, without addressing environmental and social sustainability. This paper describes a new approach adopted in Italy to plan and deliver health prevention services in an inner area of the Tuscany region (in Italy) to guarantee proximity of care and environmental and social sustainability. The project examines the design and delivery of cancer screening programmes using a mobile screening unit to maximise social benefits while minimising environmental waste. A cost analysis was developed to estimate the difference in CO2 equivalent emissions, travel costs, and productivity losses, comparing the current screening programmes against the introduction of a comprehensive full-service mobile screening unit. The results indicate that the new service model reduces direct non-medical costs incurred by the population and improves environmental sustainability. This alternative can reduce, annually, over 95,000 euros in terms of travel costs and productivity losses, as well as 35 tons of CO2-equivalent travel emissions for a population of 59,000 inhabitants in a mountainous area with around 6000 people involved in the screening programme. The study supports the need to adopt a new planning methodology that considers environmental, social, and financial sustainability jointly in the provision of public health services in rural areas.
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Affiliation(s)
- Vera Benedetto
- Interdisciplinary Research Center for Health Science, Scuola Superiore Sant'Anna, Via Martiri della Libertà, 33, Pisa, PI 56127, Italy.
| | - Francesca Ferrè
- Management and Health Laboratory, Institute of Management-Department Embeds, Scuola Superiore Sant'Anna, Via Martiri della Libertà, 33, Pisa, PI 56127, Italy
| | - Sabina Nuti
- Interdisciplinary Research Center for Health Science, Scuola Superiore Sant'Anna, Via Martiri della Libertà, 33, Pisa, PI 56127, Italy
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Guihenneuc J, Cambien G, Blanc-Petitjean P, Papin E, Bernard N, Jourdain B, Barcos I, Saez C, Dupuis A, Ayraud-Thevenot S, Migeot V. Knowledge, behaviours, practices, and expectations regarding climate change and environmental sustainability among health workers in France: a multicentre, cross-sectional study. Lancet Planet Health 2024; 8:e353-e364. [PMID: 38849178 DOI: 10.1016/s2542-5196(24)00099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/25/2024] [Accepted: 04/26/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Faced with climate change, hospitals are confronted with a dual challenge. On one hand, they need to embark on a far-reaching ecological transformation to reduce their contribution to greenhouse gas emissions and other environmental impacts; on the other hand, they need to limit the effects of climate change on their activities. We aimed to evaluate the knowledge, behaviours, practices, and expectations of health workers in French hospitals regarding climate change and environmental sustainability. METHODS This multicentre, cross-sectional study was carried out in six French hospitals from June 1, 2021 to Dec 31, 2022. All health workers at the hospitals were eligible to participate and were recruited through internal publicity. We designed a structured questionnaire consisting of five parts: participant characteristics, knowledge and perceptions of climate change, pro-environmental behaviours, practices concerning environmental sustainability actions, and expectations. A multilevel logistic regression model was used to evaluate associations between the knowledge, behaviours, and practices of health workers and the characteristics of the health workers and hospitals. FINDINGS Of 57 034 health workers across the six hospitals, 4552 (8·0%) participated in the study. Of those for whom gender data were available, 3518 (78·2%) participants were women and 979 (21·8%) were men. Participants considered energy consumption (71·0%) and waste and discharges related to medical activities (55·6%) and non-medical activities (50·2%) to be the three activities with the greatest environmental impact. On a scale of 1 (not a priority) to 10 (high priority), the median rating attributed by the participants to the commitment of their hospitals to ecological transformation was 5·0 (IQR 3·0-6·0). 1079 (23·7%) of 4552 participants had already initiated at least one environmental sustainability action in their hospital. Barriers reported by participants to the implementation of environmental sustainability-related projects were the lack of dedicated time (40·4%), hierarchical support (32·5%), methodological support (28·9%), and access to training (23·7%). The presence of a sustainable development steering committee, especially one with more than 5 years of activity, was positively associated with health workers feeling better informed about the ecological transformation of their hospital (adjusted odds ratio 1·78 [95% CI 1·29-2·45]), having better knowledge of the environmental impacts of their hospital (1·83 [1·32-2·53]), and initiating a larger number of environmental sustainability actions (1·74 [1·33-2·29]). INTERPRETATION We showed that health workers in French hospitals seem to be committed to the ecological transformation of their workplaces, and identified some drivers and barriers to further support these essential transformations. There is an urgent need to bolster training for all health workers, enhance structural frameworks within hospitals, and encourage future interdisciplinary research on the vulnerability of health-care facilities to climate change. FUNDING The University Hospital of Poitiers.
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Affiliation(s)
- Jérémy Guihenneuc
- Université de Poitiers, CNRS, EBI, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'Investigation Clinique CIC1402, Axe Santé Environnementale, Poitiers, France; Pôle BIOSPHARM, CHU de Poitiers, Poitiers, France.
| | - Guillaume Cambien
- Université de Poitiers, CNRS, EBI, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'Investigation Clinique CIC1402, Axe Santé Environnementale, Poitiers, France; Pôle BIOSPHARM, CHU de Poitiers, Poitiers, France
| | - Pauline Blanc-Petitjean
- Epidemiology and Public Health Department, CHU Rennes, Rennes, France; CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Rennes, France
| | - Emeline Papin
- Université de Poitiers, CHU de Poitiers, INSERM, Centre d'Investigation Clinique CIC1402, Axe Santé Environnementale, Poitiers, France
| | - Noëlle Bernard
- Department of Internal Medicine and Infectious Diseases, University Hospital of Bordeaux, Hôpital Saint André, Bordeaux, France
| | - Bernard Jourdain
- Sustainable Development Department, Hospital of Niort, Niort, France
| | - Isabelle Barcos
- Methodological Support and Innovation in Prevention Department, University Hospital of Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Cécile Saez
- Sustainable Development Department, University Hospital of Bordeaux, Talence, France
| | - Antoine Dupuis
- Université de Poitiers, CNRS, EBI, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'Investigation Clinique CIC1402, Axe Santé Environnementale, Poitiers, France; Pôle BIOSPHARM, CHU de Poitiers, Poitiers, France
| | - Sarah Ayraud-Thevenot
- Université de Poitiers, CNRS, EBI, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'Investigation Clinique CIC1402, Axe Santé Environnementale, Poitiers, France; Pôle BIOSPHARM, CHU de Poitiers, Poitiers, France
| | - Virginie Migeot
- Epidemiology and Public Health Department, CHU Rennes, Rennes, France; CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Rennes, France
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Barber B, Rainham DG, Tyedmers P, Vandertuin T, Ritcey G, Christie SD. Taking action towards climate-resilient, low-carbon, health systems: Perspectives from Canadian health leaders and healthcare professionals. Healthc Manage Forum 2024:8404704241252032. [PMID: 38739689 DOI: 10.1177/08404704241252032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Climate change poses significant public health and health system challenges including increased demand for health services due to chronic and acute health impacts from vector-borne diseases, heat-related illness, and injury from severe weather. As climate change worsens, so do its effects on health systems such as increasing severity of weather extremes causing damage to healthcare infrastructure and interference with supply chains. Ironically, health sectors globally are significant contributors to climate change, generating an estimated 5% of global emissions. Achieving "net zero" health systems require large-scale change with shared decision-making to coordinate a pan-Canadian approach to creating climate-resilient and low-carbon healthcare. In this article, we discuss healthcare professionals' and health leaders' perceptions of responsibility for practicing and advocating for climate-resilient and low-carbon healthcare in Canada.
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Vergara R, Chouvel R, Vergier B, Le Bail B, Négrier-Leibreich ML, Belleannée G, Rullier A, Marty M. Reducing reflex first-line prescriptions in a surgical pathology laboratory: toward sustainable practice with positive economic and clinical effects. Virchows Arch 2024:10.1007/s00428-024-03817-5. [PMID: 38730093 DOI: 10.1007/s00428-024-03817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/22/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024]
Abstract
In surgical pathology departments, reflex first-line techniques (RFLTs) are aimed at reducing workloads and addressing recent shortages of medical personnel. However, the impacts thereof on economic and diagnostic factors have been poorly addressed. Also, in the era of global warming, environmental considerations are crucial. This study assessed the economic and diagnostic efficacies of routine pathological RFLT and the quality of care and sustainability. Ten RFLTs of the Bordeaux University Hospital pathology department (six special stains, one cytology technique, and three immunohistochemical tests) were studied. First, a retrospective economic analysis evaluated the average cost of these RFLTs per slide and per year. Second, diagnostic relevance was prospectively surveyed. Third, the effects of changes made were analyzed over 2 years. The ten RFLTs were associated with average annual costs of €46,708. Diagnostic relevance analysis indicated that most stains were unnecessary; only 17% were requested as second-line techniques. Elimination of 7/10 tests afforded annual cost savings of €22,522 and reduced the workload by 5568 tests/year, without compromising the workflow or diagnostic quality. Seven of ten RFLTs could be eliminated without compromising diagnostic quality or the workflow. This afforded not only financial benefits but also positive social and environmental impacts. We offer valuable insights into appropriate practices in surgical pathology laboratories. Collaboration between the medical and technical teams was crucial; other healthcare sectors would also benefit from our approach.
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Affiliation(s)
- Rémi Vergara
- Pathology Department, Bordeaux University Hospital, Bordeaux, France.
| | - Rudy Chouvel
- Fédération Hospitalière de France, Paris, France
| | - Béatrice Vergier
- Pathology Department, Bordeaux University Hospital, Bordeaux, France
- BoRdeaux Institute of onCology (BRIC)-UMR 1312 INSERM University of Bordeaux, Bordeaux, France
| | - Brigitte Le Bail
- Pathology Department, Bordeaux University Hospital, Bordeaux, France
- BoRdeaux Institute of onCology (BRIC)-UMR 1312 INSERM University of Bordeaux, Bordeaux, France
| | | | | | - Anne Rullier
- Pathology Department, Bordeaux University Hospital, Bordeaux, France
| | - Marion Marty
- Pathology Department, Bordeaux University Hospital, Bordeaux, France
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Golemiec B, Robertson M, Poon V, Foley M, Parker CM, McGann C, O'Callaghan N, Digby GC. Improving Access to Care, Patient Costs, and Environmental Impact Through a Community Outreach Lung Cancer Rapid Assessment Clinic. JCO Oncol Pract 2024:OP2300657. [PMID: 38696740 DOI: 10.1200/op.23.00657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/26/2024] [Accepted: 03/26/2024] [Indexed: 05/04/2024] Open
Abstract
PURPOSE In Southeastern Ontario, increased patient distance from the regional lung cancer diagnostic assessment program (LDAP) is associated with a lower likelihood of patient care via LDAP while receiving care via LDAP is associated with improved survival. We implemented an LDAP outreach clinic to provide specialist assessment for patients with suspected lung cancer at a regional community hospital and assessed the impact on timeliness and accessibility of care. MATERIALS AND METHODS The Kingston Health Sciences Centre LDAP team engaged with community hospital partners to develop and launch the LDAP outreach clinic. We performed a retrospective chart review of LDAP patients (N = 1,070) before (August-November 2021; n = 234) and after implementation of the outreach clinic (November 2021-October 2022; n = 836). Descriptive data are reported as No. (%). Unpaired t tests and statistical process control charts assess for significance. A cost analysis of out-of-pocket patient costs related to travel and parking is presented in 2022 Canadian dollars (CAD). RESULTS Compared with a 3-month matched time period before (August-October 2021) and after outreach clinic (August-October 2022), the mean time from referral to assessment and time from referral to diagnosis decreased from 20.3 to 14.4 days (P = .0019) and 40.0 to 28.9 days (P = .0007), respectively. Over 12 months, the total patient travel was reduced by 8,856 km, which combined with parking cost-savings, resulted in patient out-of-pocket savings of CAD $5,755.60 (CAD $47.60/patient). Accounting for physician travel, the total travel saved was 5,688 km, corresponding to reduced CO2 emissions by 1.9 tCO2. CONCLUSION Implementation of a lung cancer outreach clinic led to improved timeliness of care, patient cost-savings, and reduced carbon footprint while serving patients in their community.
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Affiliation(s)
- Breanne Golemiec
- Department of Medicine, Queen's University, Kingston, ON, Canada
- Division of Respirology, Queen's University, Kingston, ON, Canada
| | - Madison Robertson
- Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada
| | - Vincent Poon
- Department of Medicine, Division of Medical Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Mary Foley
- Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada
| | - Christopher M Parker
- Department of Medicine, Queen's University, Kingston, ON, Canada
- Division of Respirology, Queen's University, Kingston, ON, Canada
| | - Craig McGann
- Division of Respirology, Queen's University, Kingston, ON, Canada
| | - Nicole O'Callaghan
- Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, Canada
| | - Geneviève C Digby
- Department of Medicine, Queen's University, Kingston, ON, Canada
- Division of Respirology, Queen's University, Kingston, ON, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
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Gaetani M, Uleryk E, Halgren C, Maratta C. The carbon footprint of critical care: a systematic review. Intensive Care Med 2024; 50:731-745. [PMID: 38416200 DOI: 10.1007/s00134-023-07307-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/11/2023] [Indexed: 02/29/2024]
Abstract
PURPOSE The provision of healthcare is a substantial global contributor to greenhouse gas (GHG) emissions. Several medical specialties and national health systems have begun evaluating their carbon emission contributions. The aim of this review is to summarise and describe the carbon footprint resulting from the provision of adult, paediatric and neonatal critical care. METHODS A systematic search of Embase, Cochrane and Web of Science was performed in January 2023. Studies reporting any assessment of the carbon footprint of critical care were included. No language restrictions were applied. GHG emissions from life cycle assessments (LCA) were reported, in addition to waste, electricity and water use. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed. RESULTS In total, 13 studies assessing and describing the environmental impact of 36 adult or paediatric intensive care units (ICUs) were included. Two studies described full LCAs, seven reported waste only, two provided audits of unused medical supplies, one reported electricity use, and one study described a Material Flow Analysis. The estimated carbon emissions from critical care range between 88 kg CO2e/patient/day and 178 kg CO2e/patient/day. The two predominant sources of carbon emissions in critical care originate from electricity and gas use, as well as consumables. Waste production ranged from 1.1 to 13.7 kg/patient/day in the 6 studies where mean waste could be calculated. CONCLUSION There is a significant carbon footprint that results from intensive care provision. Consumables and waste constitute important, measurable, and modifiable components of anthropogenic emissions. There remains uncertainty due to a lack of literature, several unstudied areas of carbon emissions from critical care units, and within measured areas, measurement and reporting of carbon emissions are inconsistent.
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Affiliation(s)
- Melany Gaetani
- Department of Critical Care, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Camilla Halgren
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Christina Maratta
- Department of Critical Care, Hospital for Sick Children, Toronto, Ontario, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
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Or Z, Seppänen AV. The role of the health sector in tackling climate change: A narrative review. Health Policy 2024; 143:105053. [PMID: 38537397 DOI: 10.1016/j.healthpol.2024.105053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
Abstract
Climate change is one of the largest threats to population health and has already affected the ecosystem, food production, and health and wellbeing of populations all over the world. The healthcare sector is responsible for around 5 % of greenhouse gas emissions worldwide and can play a key role in reducing global warming. This narrative review summarized the information on the role of healthcare systems in addressing climate change and strategies for reducing its negative impact to illustrate different types of actions that can support the ecological transformation of healthcare systems to help reaching sustainable development goals. A wide range of green interventions are shown to be effective to reduce the carbon footprint of healthcare and can have a meaningful impact if implemented systematically. However, these would not suffice unless accompanied by systemic mitigation strategies altering how healthcare is provided and consumed. Sustainable healthcare strategies such as reducing waste and low-value care will have direct benefits for the environment while improving economic and health outcomes. The healthcare sector has a unique opportunity to leverage its position and resources to provide a comprehensive strategy for fighting climate change and improving population health and the environment on which it depends.
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Affiliation(s)
- Zeynep Or
- Institut de recherche et documentation en économie de la santé (IRDES), France.
| | - Anna-Veera Seppänen
- Institut de recherche et documentation en économie de la santé (IRDES), France
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Sergeant M, Ly O, Kandasamy S, Anand SS, de Souza RJ. Managing greenhouse gas emissions in the terminal year of life in an overwhelmed health system: a paradigm shift for people and our planet. Lancet Planet Health 2024; 8:e327-e333. [PMID: 38729672 DOI: 10.1016/s2542-5196(24)00048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/14/2024] [Accepted: 03/22/2024] [Indexed: 05/12/2024]
Abstract
Health care contributes 4·4% of global net carbon emissions. Hospitals are resource-intensive settings, using a large amount of supplies in patient care and have high energy, ventilation, and heating needs. This Viewpoint investigates emissions related to health care in a patient's last year of life. End of life (EOL) is a period when health-care use and associated emissions production increases exponentially due primarily to hospital admissions, which are often at odds with patients' values and preferences. Potential solutions detailed within this Viewpoint are facilitating advanced care plans with patients to ensure their EOL wishes are clear, beginning palliative care interventions earlier when treating a life-limiting illness, deprescribing unnecessary medications because medications and their supply chains make up a significant portion of health-care emissions, and, enhancing access to low-intensity community care settings (eg, hospices) within the last year of life if home care is not available. Our analysis was done using Canadian data, but the findings can be applied to other high-income countries.
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Affiliation(s)
- Myles Sergeant
- Department of Family Medicine, Michael G DeGroote School of Medicine, Hamilton, ON, Canada
| | - Olivia Ly
- Department of Family Medicine, Michael G DeGroote School of Medicine, Hamilton, ON, Canada
| | - Sujane Kandasamy
- Department of Child and Youth Studies, Brock University, St Catherine's, ON, Canada
| | - Sonia S Anand
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
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Keil M, Frehse L, Hagemeister M, Knieß M, Lange O, Kronenberg T, Rogowski W. Carbon footprint of healthcare systems: a systematic review of evidence and methods. BMJ Open 2024; 14:e078464. [PMID: 38688670 PMCID: PMC11086491 DOI: 10.1136/bmjopen-2023-078464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE Given the demand for net-zero healthcare, the carbon footprint (CF) of healthcare systems has attracted increasing interest in research in recent years. This systematic review investigates the results and methodological transparency of CF calculations of healthcare systems. The methodological emphasis lies specifically on input-output based calculations. DESIGN Systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. DATA SOURCES PubMed, Web of Science, EconBiz, Scopus and Google Scholar were initially searched on 25 November 2019. Search updates in PubMed and Web of Science were considered until December 2023. The search was complemented by reference tracking within all the included studies. ELIGIBILITY CRITERIA We included original studies that calculated and reported the CF of one or more healthcare systems. Studies were excluded if the specific systems were not named or no information on the calculation method was provided. DATA EXTRACTION AND SYNTHESIS Within the initial search, two independent reviewers searched, screened and extracted information from the included studies. A checklist was developed to extract information on results and methodology and assess the included studies' transparency. RESULTS 15 studies were included. The mean ratio of healthcare system emissions to total national emissions was 4.9% (minimum 1.5%; maximum 9.8%), and CFs were growing in most countries. Hospital care led to the largest relative share of the total CF. At least 71% of the methodological items were reported by each study. CONCLUSIONS The results of this review show that healthcare systems contribute substantially to national carbon emissions, and hospitals are one of the main contributors in this regard. They also show that mitigation measures can help reduce emissions over time. The checklist developed here can serve as a reference point to help make methodological decisions in future research reports as well as report homogeneous results.
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Affiliation(s)
- Mattis Keil
- Department of Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, Bremen, Germany
- Joint research cluster "Healthy City Bremen" of the University of Bremen, Bremen University of Applied Sciences and Apollon University of Applied Sciences Bremen, Bremen, Germany
| | - Leonie Frehse
- Professional Public Decision Making, Faculty of Cultural Studies, University of Bremen, Bremen, Germany
| | - Marco Hagemeister
- Professional Public Decision Making, Faculty of Cultural Studies, University of Bremen, Bremen, Germany
| | - Mona Knieß
- Professional Public Decision Making, Faculty of Cultural Studies, University of Bremen, Bremen, Germany
| | - Oliver Lange
- Department of Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, Bremen, Germany
- Leibniz ScienceCampus Digital Public Health, Bremen, Germany
| | - Tobias Kronenberg
- Department of Economics, Bochum University of Applied Sciences, Bochum, Germany
| | - Wolf Rogowski
- Department of Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, Bremen, Germany
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Farzad M, Naqui Z, MacDermid J, Cuypers S. Sustainable practices in hand therapy: a global perspective. J Hand Surg Eur Vol 2024:17531934241246451. [PMID: 38647160 DOI: 10.1177/17531934241246451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Given its significant environmental footprint, healthcare sustainability is paramount. This study delves into the contributory role of hand therapy, assessing hand therapists' comprehension, implementation and barriers to sustainable practices, focusing on orthotic fabrication. A global survey distributed via social media and professional networks collected data on sustainability awareness, practices and educational needs from 113 respondents, primarily from North America (34%) and Europe (32%). Although 91% recognized climate change, only 34% practised sustainability. Despite 57% attempting eco-friendly actions in orthotic fabrication, such as reusing components (65%), knowledge of reusable materials was low (17%) and recycling thermoplastics was inadequate (74.3%). The main barriers were lack of awareness (59%), material scarcity (56.6%) and time constraints (54%). The findings underscore the urgent need for enhanced education, better resource availability and policy reforms to close the gap between awareness and action, promoting sustainability in hand therapy.
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Affiliation(s)
- Maryam Farzad
- Hand and Upper Limb Center, St. Joseph's Health Center, School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
- School of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Zaf Naqui
- Department of Trauma, Orthopaedic and Plastic Surgery, Salford Royal Hospital, Manchester, UK
| | - Joy MacDermid
- Physical Therapy and Surgery, Western University, London, Ontario, Canada
- Clinical Research Lab, Hand and Upper Limb Center, St. Joseph's Health Center, London, Ontario, Canada
- Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Luque-Alcaraz OM, Aparicio-Martínez P, Gomera A, Vaquero-Abellán M. The environmental awareness of nurses as environmentally sustainable health care leaders: a mixed method analysis. BMC Nurs 2024; 23:229. [PMID: 38570845 PMCID: PMC10988952 DOI: 10.1186/s12912-024-01895-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND People worldwide are concerned with the possibility of climate change, microplastics, air pollution, and extreme weather affecting human health. Countries are implementing measures to reduce environmental impacts. Nurses play a vital role, primarily through Green Teams, in the process of promoting sustainable practices and minimizing the environmental footprint of health care facilities. Despite existing knowledge on this topic, assessing nurses' environmental awareness and behavior, including the barriers they face, is crucial with regard to improving sustainable health care practices. AIM To analyze the environmental awareness and behavior of nurses, especially nurse leaders, as members of the Green Team and to identify areas for improvement with regard to the creation of a sustainable environment. METHODS A sequential mixed-method study was conducted to investigate Spanish nurses. The study utilized an online survey and interviews, including participant observation. An online survey was administered to collect quantitative data regarding environmental awareness and behavior. Qualitative interviews were conducted with environmental nurses in specific regions, with a focus on Andalusia, Spain. RESULTS Most of the surveyed nurses (N = 314) exhibited moderate environmental awareness (70.4%), but their environmental behavior and activities in the workplace were limited (52.23% of participants rarely performed relevant actions, and 35.03% indicated that doing so was difficult). Nurses who exhibited higher levels of environmental awareness were more likely to engage in sustainable behaviors such as waste reduction, energy conservation, and environmentally conscious purchasing decisions (p < 0.05). Additionally, the adjusted model indicated that nurses' environmental behavior and activities in the workplace depend on the frequency of their environmental behaviors outside work as well as their sustainable knowledge (p < 0.01). The results of the qualitative study (N = 10) highlighted certain limitations in their daily practices related to environmental sustainability, including a lack of time, a lack of bins and the pandemic. Additionally, sustainable environmental behavior on the part of nursing leadership and the Green Team must be improved. CONCLUSIONS This study revealed that most nurses have adequate knowledge, attitudes, and behaviors related to environmental sustainability both inside and outside the workplace. Limitations were associated with their knowledge and behaviors outside of work. This study also highlighted the barriers and difficulties that nurses face in their attempts to engage in adequate environmental behaviors in the workplace. Based on these findings, interventions led by nurses and the Green Team should be developed to promote sustainable behaviors among nurses and address the barriers and limitations identified in this research.
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Affiliation(s)
- Olga María Luque-Alcaraz
- Neurosurgery Department, Hospital Universitario Reina Sofía, Andalusian Health Care System, 14071, Cordoba, Spain
- Environmental Protection Office (SEPA), University of Córdoba, Campus Rabanales, 14014, Córdoba, Spain
- GE 10 Research Groups of Clinical-Epidemiological Research in Primary Care, University Biomedical Program for Occupational Medicine, Occupational Epidemiology and Sustainability, Maimonides Institute of Biomedicine of Cordoba (IMIBIC), 14071, Cordoba, Spain
- GA16 Lifestyles, Innovation and Health, Maimonides Institute of Biomedicine of Cordoba (IMIBIC), 14071, Cordoba, Spain
| | - Pilar Aparicio-Martínez
- GE 10 Research Groups of Clinical-Epidemiological Research in Primary Care, University Biomedical Program for Occupational Medicine, Occupational Epidemiology and Sustainability, Maimonides Institute of Biomedicine of Cordoba (IMIBIC), 14071, Cordoba, Spain.
- Nursing, Pharmacology and Physiotherapy Department, Faculty of Medicine and Nursing, University of Cordoba, 14071, Cordoba, Spain.
| | - Antonio Gomera
- Environmental Protection Office (SEPA), University of Córdoba, Campus Rabanales, 14014, Córdoba, Spain
| | - Manuel Vaquero-Abellán
- Environmental Protection Office (SEPA), University of Córdoba, Campus Rabanales, 14014, Córdoba, Spain
- GE 10 Research Groups of Clinical-Epidemiological Research in Primary Care, University Biomedical Program for Occupational Medicine, Occupational Epidemiology and Sustainability, Maimonides Institute of Biomedicine of Cordoba (IMIBIC), 14071, Cordoba, Spain
- Nursing, Pharmacology and Physiotherapy Department, Faculty of Medicine and Nursing, University of Cordoba, 14071, Cordoba, Spain
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Heffernan A, Lalande A, Chadha R, MacNeill A, Chadha NK. Carbon savings potential of virtual care in obstructive sleep apnea and otitis media with effusion. Laryngoscope Investig Otolaryngol 2024; 9:e1221. [PMID: 38623079 PMCID: PMC11017970 DOI: 10.1002/lio2.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/07/2024] [Accepted: 01/16/2024] [Indexed: 04/17/2024] Open
Abstract
Objective To determine the carbon savings potential of incorporating virtual care into surgical care pathways for pediatric patients with obstructive sleep apnea or otitis media with effusion. Methods Pediatric patients with obstructive sleep apnea or otitis media with effusion were not enrolled, instead, a modeling cohort study design was used. This study utilized the British Columbia healthcare system and geography to model emissions. Care pathways were developed for pediatric patients with obstructive sleep apnea or otitis media with effusion requiring care at a tertiary pediatric center. Home addresses were located at the geographical center of the two most populated municipalities within each of the 10 most populated regional districts in 2020. Virtual visits replaced up to three clinically equivalent in-person visits. Emissions (kgCO2e) for transport and virtual visits were estimated. Population-weighted means and descriptive statistics were calculated. Results Utilizing 1, 2, or 3 virtual visits in the obstructive sleep apnea care pathway yielded potential emissions savings of 19.9%, 39.9%, and 59.8% respectively. Integrating 1, 2, or 3 virtual visits into the otitis media with effusion care pathway produced potential emissions savings of 16.6%, 33.2%, and 49.7%, respectively. Integrating 3 virtual visits can save up to 2156.8 kgCO2e per patient. Conclusions Appropriately conducting up to 50% of clinical encounters virtually for children with obstructive sleep apnea or otitis media with effusion reduced theoretical carbon emissions. For a single child, emission savings could reach over 2150 kgCO2e. Level of Evidence Level 5.
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Affiliation(s)
- Austin Heffernan
- Division of Otolaryngology‐Head and Neck Surgery, (Department of Surgery)University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Annie Lalande
- Institute for Resources, Environment and SustainabilityUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of SurgeryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Rashmi Chadha
- Department of Family PracticeUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Vancouver General HospitalVancouverBritish ColumbiaCanada
| | - Andrea MacNeill
- Department of SurgeryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Vancouver General HospitalVancouverBritish ColumbiaCanada
| | - Neil K. Chadha
- Division of Otolaryngology‐Head and Neck Surgery, (Department of Surgery)University of British ColumbiaVancouverBritish ColumbiaCanada
- Division of Pediatric Otolaryngology‐Head and Neck SurgeryBC Children's HospitalVancouverBritish ColumbiaCanada
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Leddin D, Singh H, Armstrong D, Cheyne K, Galts C, Igoe J, Leontiadis G, McGrath J, Pray C, Sadowski D, Shahidi N, Sinclair P, Tse F, Yanofsky R. The Canadian Association of Gastroenterology's New Climate Change Committee. J Can Assoc Gastroenterol 2024; 7:135-136. [PMID: 38596799 PMCID: PMC10999766 DOI: 10.1093/jcag/gwae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Affiliation(s)
- Desmond Leddin
- Division of Digestive Care & Endoscopy, Department of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Harminder Singh
- Section of Gastroenterology, Deparment of Internal Medicine, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - David Armstrong
- Division of Gastroenterology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Kelsey Cheyne
- Canadian Digestive Health Foundation, Oakville, ON L6M 4J2, Canada
| | - Ciaran Galts
- Division of Gastroenterology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - John Igoe
- Division of Digestive Care & Endoscopy, Department of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | | | - Jerry McGrath
- Department of Medicine, Memorial University, St. John’s, NL A1B 3V6, Canada
| | - Cara Pray
- Division of Gastroenterology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Daniel Sadowski
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Neal Shahidi
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | | | - Frances Tse
- Division of Gastroenterology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Russell Yanofsky
- Division of Gastroenterology, University of Toronto, Toronto, ON M5S 1A1, Canada
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Thomas S, Kennett A, Fullerton C, Boyd H. Nephrology Nurses: Essential Professionals in Sustainable Kidney Care. Can J Kidney Health Dis 2024; 11:20543581241234730. [PMID: 38463382 PMCID: PMC10921849 DOI: 10.1177/20543581241234730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/15/2024] [Indexed: 03/12/2024] Open
Abstract
Purpose The increasing frequency of extreme climate events underscores the need for urgent action on climate change. The health care system contributes 4.6% of greenhouse gas emissions (GHGs) in Canada; thus, it is a major contributor to the country's carbon footprint. Kidney care in particular can involve high amounts of waste (eg, plastic and consumable waste associated with dialysis, transportation, emissions, energy, and water consumption). Therefore, sustainability initiatives within the health care system, and especially in the context of kidney care, have great potential to make a positive impact on planetary health. Here, we outline ways in which nephrology nurses can expand our duty of care to the environment and incorporate sustainability into our work. Sources of information A small advisory group of nephrology nurses in partnership with the Canadian Association of Nurses for the Environment (CANE) assessed ways that sustainable practices can be incorporated into nephrology nursing. Drawing on the Planetary Health Care model used by the Canadian Society of Nephrology: Sustainable Nephrology Action Planning (SNAP) committee, we assessed how the model could be adapted in the context of kidney care using 3 main actionable themes in their work: reducing the demand for health services, matching the supply of health services with demand, and reducing emissions from the supply of health services. We also reviewed and selected real-world examples of initiatives pursued by colleagues. Key findings Through this established framework, we provide recommendations and case examples for nephrology nurses to expand our duty of care to the environment. We describe nursing-led strategies used in Canada to improve environmental sustainability in kidney programs and consider their applicability to other renal programs. In 1 case example, we show how a simple nurse-led initiative at a single dialysis clinic can lower plastic waste and associated costs by $2042.59 per year. More broadly, we provide recommendations and actions for nephrology nurses to improve environmental sustainability in kidney care. Limitations Nurses in Canada have many responsibilities within limited timeframes, making it essential to choose sustainable practices that do not exacerbate burnout and high workloads. For sustainable practices to be successful, nurses must integrate them into their existing workflows.
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Affiliation(s)
- Sarah Thomas
- BC Renal, British Columbia Provincial Health Services Authority, Vancouver, Canada
- Canadian Association of Nurses for the Environment British Columbia, Canada
| | - Anita Kennett
- British Columbia Health Authorities, Island Health Authority, Duncan, Canada
| | - Claire Fullerton
- Canadian Association of Nurses for the Environment British Columbia, Canada
- British Columbia Health Authorities, Island Health Authority, Duncan, Canada
| | - Helen Boyd
- Canadian Association of Nurses for the Environment British Columbia, Canada
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16
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White S, Montgomery H. The need for radical climate interventions: six years to secure humanity's 'liveable future'. Anaesthesia 2024; 79:232-236. [PMID: 38205557 DOI: 10.1111/anae.16160] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 01/12/2024]
Affiliation(s)
- S White
- Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - H Montgomery
- Intensive Care Medicine, Centre for Health and Human Performance, University College London, London, UK
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17
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Wilkinson AJK, Maslova E, Janson C, Radhakrishnan V, Quint JK, Budgen N, Tran TN, Xu Y, Menzies-Gow A, Bell JP. Greenhouse gas emissions associated with suboptimal asthma care in the UK: the SABINA healthCARe-Based envirONmental cost of treatment (CARBON) study. Thorax 2024; 79:thorax-2023-220259. [PMID: 38413192 DOI: 10.1136/thorax-2023-220259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/17/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Poorly controlled asthma is associated with increased morbidity and healthcare resource utilisation (HCRU). Therefore, to quantify the environmental impact of asthma care, this retrospective, cohort, healthCARe-Based envirONmental cost of treatment (CARBON) study estimated greenhouse gas (GHG) emissions in the UK associated with the management of well-controlled versus poorly controlled asthma. METHODS Patients with current asthma (aged ≥12 years) registered with the Clinical Practice Research Datalink (2008‒2019) were included. GHG emissions, measured as carbon dioxide equivalent (CO2e), were estimated for asthma-related medication use, HCRU and exacerbations during follow-up of patients with asthma classified at baseline as well-controlled (<3 short-acting β2-agonist (SABA) canisters/year and no exacerbations) or poorly controlled (≥3 SABA canisters/year or ≥1 exacerbation). Excess GHG emissions due to suboptimal asthma control included ≥3 SABA canister prescriptions/year, exacerbations and any general practitioner and outpatient visits within 10 days of hospitalisation or an emergency department visit. RESULTS Of the 236 506 patients analysed, 47.3% had poorly controlled asthma at baseline. Scaled to the national level, the overall carbon footprint of asthma care in the UK was 750 540 tonnes CO2e/year, with poorly controlled asthma contributing excess GHG emissions of 303 874 tonnes CO2e/year, which is equivalent to emissions from >124 000 houses in the UK. Poorly controlled versus well-controlled asthma generated 3.1-fold higher overall and 8.1-fold higher excess per capita carbon footprint, largely SABA-induced, with smaller contributions from HCRU. CONCLUSIONS These findings suggest that addressing the high burden of poorly controlled asthma, including curbing high SABA use and its associated risk of exacerbations, may significantly alleviate asthma care-related carbon emissions.
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Affiliation(s)
| | | | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | - Jennifer K Quint
- National Heart Lung Institute, Imperial College London, London, UK
| | - Nigel Budgen
- Global Sustainability, AstraZeneca, Macclesfield, UK
| | - Trung N Tran
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
| | - Yang Xu
- BioPharmaceuticals Medical, AstraZeneca UK Ltd, Cambridge, UK
| | | | - John P Bell
- BioPharmaceuticals Medical, AstraZeneca Switzerland, Baar, Switzerland
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18
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Jacob S, Schust SA, Angele M, Werner J, Guba M, Börner N. A long road ahead. A German national survey study on awareness and willingness of surgeons towards the carbon footprint of modern surgical procedures. Heliyon 2024; 10:e25198. [PMID: 38327395 PMCID: PMC10847866 DOI: 10.1016/j.heliyon.2024.e25198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
Background Climate change may well be the "largest threat" to humankind. Changes to our climate system lead to a decrease in global health. The healthcare sector presents one of the largest carbon footprints across all industries. Since surgical departments have one of the largest carbon footprints within the healthcare sector, they represent an area with vast opportunities for improvement. To drive change, it is vital to create awareness of these issues and encourage engagement in changes among people working in the healthcare industry. Methods We conducted an anonymous cross-sectional survey study to assess awareness among surgeons regarding the impact of healthcare systems on climate change. The questions were designed to investigate surgeons' willingness to accept and promote changes to reduce carbon footprints. Participants included surgical professionals of all ages and levels of expertise. Results A total of 210 participants completed the survey in full and were included in the evaluation. Sixty percent emphasized a lack of information and the need for personal education. Over 90 % expressed concern for the environment and a strong desire to gain new insights. Provided that clinical performance remains the same, more than 70 % are willing to embrace carbon-friendly alternatives. In this context, all participants accepted the additional time required for training and initially increased personal efforts to achieve equal performance. Conclusion Limited awareness and information about carbon footprints were observed in surgical departments in German hospitals. Nevertheless, the vast majority of surgeons across all age groups are more than willing to acquire new insights and adapt to changes in order to reduce energy consumption and carbon dioxide production.
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Affiliation(s)
- Sven Jacob
- Ludwig-Maximilians-University, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | - Sophie Anne Schust
- Ludwig-Maximilians-University, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | - Martin Angele
- Ludwig-Maximilians-University, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | - Jens Werner
- Ludwig-Maximilians-University, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | - Markus Guba
- Ludwig-Maximilians-University, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | - Nikolaus Börner
- Ludwig-Maximilians-University, Department of General, Visceral and Transplantation Surgery, Munich, Germany
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Meiklejohn DA, Khan ZH, Nuñez KM, Imhof L, Osmani S, Benavidez AC, Tarefder R. Environmental Impact of Adult Tonsillectomy: Life Cycle Assessment and Cost Comparison of Techniques. Laryngoscope 2024; 134:622-628. [PMID: 37421241 DOI: 10.1002/lary.30866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES To quantify and compare the cost and environmental impact of different techniques for adult tonsillectomy surgery, and to identify target areas for impact reduction. METHODS Fifteen consecutive adult tonsillectomy surgeries were prospectively randomized to one of three tonsillectomy techniques: cold, monopolar electrocautery, or low-temperature radiofrequency ablation (Coblation). Life cycle assessment was used to comprehensively evaluate the environmental impact of study surgeries. Outcomes assessed included multiple measures of environmental impact, including greenhouse gas (GHG) emissions, and cost. Environmental impact measures were analyzed to identify highest-yield areas for improvement, and outcomes were compared between surgical techniques using statistical analysis. RESULTS GHG emissions for cold, monopolar electrocautery, and Coblation techniques were 157.6, 184.5, and 204.7 kilograms of carbon dioxide equivalents (kgCO2 -eq) per surgery, respectively, with costs totaling $472.51, $619.10, and $715.53 per surgery, respectively. Regardless of surgery technique, anesthesia medications and disposable equipment contributed most to environmental harm. Cold technique demonstrated reduced environmental impact related to disposable surgical equipment in the categories of greenhouse gas emissions, acidification of soil and water, eutrophication of air, ozone depletion, release of carcinogenic, and non-carcinogenic toxic substances, and respiratory pollutant production (p < 0.05 for all comparisons with other techniques). CONCLUSION Within the boundaries of operating room processes, cold technique minimizes cost and environmental impact of adult tonsillectomy surgery, with statistical significance noted in the impact of disposable surgical equipment. Areas of highest potential for improvement identified include reducing use of disposable equipment and collaboration with the Anesthesiology care team to streamline medication use. LEVEL OF EVIDENCE 2, randomized trial Laryngoscope, 134:622-628, 2024.
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Affiliation(s)
- Duncan A Meiklejohn
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, Albuquerque, New Mexico, U.S.A
| | - Zafrul H Khan
- Department of Civil Engineering, University of New Mexico, Albuquerque, New Mexico, U.S.A
| | - Karyn M Nuñez
- Alaska Native Tribal Health Consortium, Providence Anchorage Anesthesia Medical Group, Anchorage, Alaska, U.S.A
| | - Lee Imhof
- Department of Planning and Construction, University of New Mexico Hospital, Albuquerque, New Mexico, U.S.A
| | - Sabah Osmani
- University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A
| | - Amaris C Benavidez
- University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A
| | - Rafiqul Tarefder
- Department of Civil Engineering, University of New Mexico, Albuquerque, New Mexico, U.S.A
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Carrandi A, Nguyen C, Tse WC, Taylor C, McGain F, Thompson K, Hensher M, McAlister S, Higgins AM. How environmental impact is considered in economic evaluations of critical care: a scoping review. Intensive Care Med 2024; 50:36-45. [PMID: 38191675 PMCID: PMC10810918 DOI: 10.1007/s00134-023-07274-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/11/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Health care is a major contributor to climate change, and critical care is one of the sector's highest carbon emitters. Health economic evaluations form an important component of critical care and may be useful in identifying economically efficient and environmentally sustainable strategies. The purpose of this scoping review was to synthesise available literature on whether and how environmental impact is considered in health economic evaluations of critical care. METHODS A robust scoping review methodology was used to identify studies reporting on environmental impact in health economic evaluations of critical care. We searched six academic databases to locate health economic evaluations, costing studies and life cycle assessments of critical care from 1993 to present. RESULTS Four studies met the review's inclusion criteria. Of the 278 health economic evaluations of critical care identified, none incorporated environmental impact into their assessments. Most included studies (n = 3/4) were life cycle assessments, and the remaining study was a prospective observational study. Life cycle assessments used a combination of process-based data collection and modelling to incorporate environmental impact into their economic assessments. CONCLUSIONS Health economic evaluations of critical care have not yet incorporated environmental impact into their assessments, and few life cycle assessments exist that are specific to critical care therapies and treatments. Guidelines and standardisation regarding environmental data collection and reporting in health care are needed to support further research in the field. In the meantime, those planning health economic evaluations should include a process-based life cycle assessment to establish key environmental impacts specific to critical care.
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Affiliation(s)
- Alayna Carrandi
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Level 3, Melbourne, VIC, 3004, Australia
| | - Christina Nguyen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Level 3, Melbourne, VIC, 3004, Australia
- School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Wai Chung Tse
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Level 3, Melbourne, VIC, 3004, Australia
- School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Colman Taylor
- Faculty of Medicine, Critical Care Division, The George Institute for Global Health, University of New South Wales Sydney, Sydney, Australia
| | - Forbes McGain
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- Department of Anaesthesia, Western Health, Footscray, VIC, Australia
- Department of Intensive Care, Western Health, Footscray, VIC, Australia
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Kelly Thompson
- Faculty of Medicine, Critical Care Division, The George Institute for Global Health, University of New South Wales Sydney, Sydney, Australia
- Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
| | - Martin Hensher
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Scott McAlister
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia
| | - Alisa M Higgins
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Level 3, Melbourne, VIC, 3004, Australia.
- Faculty of Medicine, Critical Care Division, The George Institute for Global Health, University of New South Wales Sydney, Sydney, Australia.
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Merino-Urrutia W, Cárcamo-Fuentes C, Peña M, Martinez-Zapata MJ. Contribution of hospitals and clinical services to global warming: protocol for a scoping review. BMJ Open 2023; 13:e072227. [PMID: 38135310 DOI: 10.1136/bmjopen-2023-072227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Climate change is one of the greatest threats to public health today, placing considerable pressure on the healthcare sector. During patient care processes, hospital facilities contribute to greenhouse gas emissions through the use of greater resources and higher energy consumption. Consequently, there is growing interest among researchers, universities, organisations and governments to study the impact of the healthcare sector on the environment and to develop strategies to mitigate its effects. The aim of this scoping review is to determine the extent and nature of current literature on global warming from hospitals and clinical services, and ways in which they contribute to its effect. Planning and execution of future research are possible once those areas with existing gaps are identified. METHODS AND ANALYSIS A broad literature search will be carried out to illustrate the ways in which hospitals and clinical services, processes and activities contribute to climate change. Our protocol was drafted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The final protocol was registered prospectively with the Open Science Framework. All identified studies indexed in Medline, Scopus and Embase will be examined. ETHICS AND DISSEMINATION This project is literature-based research; therefore, it does not require ethical approval. The results will be presented to researchers as well as policymakers in this particular area, via conferences, webinars, podcasts and online events. A peer-reviewed publication will be submitted to specific journals of interest.
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Affiliation(s)
- Waldo Merino-Urrutia
- Cirugía, Traumatología y Anestesia. Capacitación, investigación y gestión para la salud basada en la evidencia (CIGES), Universidad de la Frontera, Facultad de Medicina, Temuco, Araucanía, Chile
| | - Claudio Cárcamo-Fuentes
- Departamento de enfermería, Universidad de la Frontera Facultad de Medicina, Temuco, Araucanía, Chile
| | - Mauricio Peña
- Hospital Hernán Henríquez Aravena, Centro de responsabilidad Cardiovascular, Temuco, Araucanía, Chile
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Berthelot S, Longtin Y, Margni M, Guertin JR, LeBlanc A, Marx T, Mangou K, Bluteau A, Mantovani D, Mikhaylin S, Bergeron F, Dancause V, Desjardins A, Lahrichi N, Martin D, Sossa CJ, Lachapelle P, Genest I, Schaal S, Gignac A, Tremblay S, Hufty É, Bélanger L, Beatty E. Postpandemic Evaluation of the Eco-Efficiency of Personal Protective Equipment Against COVID-19 in Emergency Departments: Proposal for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e50682. [PMID: 38060296 PMCID: PMC10739239 DOI: 10.2196/50682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a profound impact on emergency department (ED) care in Canada and around the world. To prevent transmission of COVID-19, personal protective equipment (PPE) was required for all ED care providers in contact with suspected cases. With mass vaccination and improvements in several infection prevention components, our hypothesis is that the risks of transmission of COVID-19 will be significantly reduced and that current PPE use will have economic and ecological consequences that exceed its anticipated benefits. Evidence is needed to evaluate PPE use so that recommendations can ensure the clinical, economic, and environmental efficiency (ie, eco-efficiency) of its use. OBJECTIVE To support the development of recommendations for the eco-efficient use of PPE, our research objectives are to (1) estimate the clinical effectiveness (reduced transmission, hospitalizations, mortality, and work absenteeism) of PPE against COVID-19 for health care workers; (2) estimate the financial cost of using PPE in the ED for the management of suspected or confirmed COVID-19 patients; and (3) estimate the ecological footprint of PPE use against COVID-19 in the ED. METHODS We will conduct a mixed method study to evaluate the eco-efficiency of PPE use in the 5 EDs of the CHU de Québec-Université Laval (Québec, Canada). To achieve our goals, the project will include four phases: systematic review of the literature to assess the clinical effectiveness of PPE (objective 1; phase 1); cost estimation of PPE use in the ED using a time-driven activity-based costing method (objective 2; phase 2); ecological footprint estimation of PPE use using a life cycle assessment approach (objective 3; phase 3); and cost-consequence analysis and focus groups (integration of objectives 1 to 3; phase 4). RESULTS The first 3 phases have started. The results of these phases will be available in 2023. Phase 4 will begin in 2023 and results will be available in 2024. CONCLUSIONS While the benefits of PPE use are likely to diminish as health care workers' immunity increases, it is important to assess its economic and ecological impacts to develop recommendations to guide its eco-efficient use. TRIAL REGISTRATION PROSPERO CRD42022302598; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302598. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50682.
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Affiliation(s)
- Simon Berthelot
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, QC, Canada
| | | | - Manuele Margni
- Ecole Polytechnique, Université de Montréal, Montréal, QC, Canada
| | - Jason Robert Guertin
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Annie LeBlanc
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Tania Marx
- Services des urgences, Centre hospitalier universitaire de Besançon, Besançon, France
| | - Khadidiatou Mangou
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Ariane Bluteau
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Diego Mantovani
- Axe Médecine régénératrice, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Sergey Mikhaylin
- EcoFoodLab, Département des sciences de aliments, Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Québec, QC, Canada
| | | | | | | | - Nadia Lahrichi
- Ecole Polytechnique, Université de Montréal, Montréal, QC, Canada
| | - Danielle Martin
- Fashion Design and Creative Direction, Toronto Metropolitan University, Toronto, ON, Canada
| | | | | | | | | | - Anne Gignac
- CHU de Québec-Université Laval, Québec, QC, Canada
| | | | - Éric Hufty
- CHU de Québec-Université Laval, Québec, QC, Canada
| | | | - Erica Beatty
- Département de médecine d'urgence, Hôpital Montfort, Ottawa, ON, Canada
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Downey GP. Medical Industry Contributions to the Climate Crisis: Behind the Green Drapes. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2023; 7:228-231. [PMID: 38314052 PMCID: PMC10836222 DOI: 10.1080/24745332.2023.2268075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/25/2023] [Indexed: 02/06/2024]
Abstract
The climate crisis is rapidly unfolding with immediate, disastrous consequences including rising surface temperatures, melting of icecaps and glaciers, rising of sea levels, and destructive wildfires spanning the globe. The impact of these climate changes on human health is broad, ranging from immediate heat-related deaths to acute and chronic respiratory and cardiovascular illness. Ironically, the healthcare industry itself contributes to climate change in many ways including waste generation, energy consumption, pharmaceutical production, equipment manufacturing, transportation, and infrastructure. In addition to these obvious ways, the use of HFA-propelled MDIs contributes significantly to the climate footprint of healthcare and is easily addressed immediately by changing to DPIs and soft mist inhalers where feasible and appropriate based on patient needs, safety, and availability of inhalers. Implementing carbon offset programs, investing in research and development, and raising awareness among healthcare professionals are crucial components to reform. The healthcare industry must lead by example and commit to long term sustainable practices that not only mitigate the environmental footprint of the healthcare industry but also improve patient outcomes.
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Affiliation(s)
- Gregory P Downey
- Departments of Medicine, Pediatrics, and Immunology and Genomic Medicine, National Jewish Health, Denver, CO USA
- Departments of Medicine, and Immunology and Microbiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO USA
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Piscitelli P, Karaj S, Miani A, Kyriakides TC, Greco E, Colicino E, Bray A, Simón F, Vasiliou V, Baccarelli AA. How Healthcare Systems Negatively Impact Environmental Health? The Need for Institutional Commitment to Reduce the Ecological Footprint of Medical Services. EPIDEMIOLOGIA 2023; 4:521-524. [PMID: 38131675 PMCID: PMC10871105 DOI: 10.3390/epidemiologia4040043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
The global healthcare industry plays a crucial role in preserving human health and well-being [...].
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Affiliation(s)
- Prisco Piscitelli
- Italian Society of Environmental Medicine (SIMA), Viale di Porta Vercellina, 9, 20123 Milan, Italy; (P.P.); (E.G.)
- Department of Experimental Medicine, University of Salento, 73100 Lecce, Italy
- Local Health Authority ASL Le, 73100 Lecce, Italy;
| | - Stela Karaj
- Faculty of Social Sciences, European University of Tirana, 1000 Tirana, Albania
| | - Alessandro Miani
- Italian Society of Environmental Medicine (SIMA), Viale di Porta Vercellina, 9, 20123 Milan, Italy; (P.P.); (E.G.)
| | - Tassos C. Kyriakides
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, USA;
| | - Enrico Greco
- Italian Society of Environmental Medicine (SIMA), Viale di Porta Vercellina, 9, 20123 Milan, Italy; (P.P.); (E.G.)
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, 34127 Trieste, Italy
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, Ichan School of Medicine, Mount Sinai Hospital, New York, NY 10029, USA;
| | - Antonio Bray
- Local Health Authority ASL Le, 73100 Lecce, Italy;
| | | | - Vasilis Vasiliou
- Department of Environmental Health, Yale School of Public Health, New Haven, CT 06510, USA;
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25
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Sergeant M, Do J, Hategan A. Sustainable practice: Sustainable prescribing of iron replacement therapy. BMJ 2023; 383:e075741. [PMID: 37931931 DOI: 10.1136/bmj-2023-075741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Affiliation(s)
- Myles Sergeant
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Do
- Medication Information, Quality, and Safety (MedIQS), Pharmacy Department, Sunnybrook HSC, Toronto, Ontario, Canada
| | - Ana Hategan
- Division of Geriatric Psychiatry, Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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26
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Quantz D, Wong GY, Liang K. Patient perspectives on the environmental impact of inhalers: A survey in British Columbia. Can Pharm J (Ott) 2023; 156:298-302. [PMID: 38024456 PMCID: PMC10655797 DOI: 10.1177/17151635231202980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 12/01/2023]
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Duffy J, Slutzman JE, Thiel CL, Landes M. Sustainable Purchasing Practices: A Comparison of Single-use and Reusable Pulse Oximeters in the Emergency Department. West J Emerg Med 2023; 24:1034-1042. [PMID: 38165184 PMCID: PMC10754185 DOI: 10.5811/westjem.58258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 04/03/2023] [Accepted: 08/11/2023] [Indexed: 01/03/2024] Open
Abstract
Background Delivering healthcare requires significant resources and creates waste that pollutes the environment, contributes to the climate crisis, and harms human health. Prior studies have generally shown durable, reusable medical devices to be environmentally superior to disposables, but this has not been investigated for pulse oximetry probes. Objective Our goal was to compare the daily carbon footprint of single-use and reusable pulse oximeters in the emergency department (ED). Methods Using a Life Cycle Assessment (LCA), we analyzed greenhouse gas (GHG) emissions from pulse oximeter use in an urban, tertiary care ED, that sees approximately 150 patients per day. Low (387 uses), moderate (474 uses), and high use (561 uses), as well as cleaning scenarios, were modelled for the reusable oximeters and compared to the daily use of single-use oximeters (150 uses). We calculated GHG emissions, measured in kilograms of carbon dioxide equivalents (kgCO2e), across all life cycle stages using life-cycle assessment software and the ecoinvent database. We also carried out an uncertainty analysis using Monte Carlo methodology and calculated the break-even point for reusable oximeters. Results Per day of use, reusable oximeters produced fewer greenhouse gases in low-, moderate-, and high-use scenarios compared to disposable oximeters: 3.9 kgCO2e, 4.9 kgCO2e, 5.7 kgCO2e vs 23.4 kgCO2e, respectively). An uncertainty analysis showed there was no overlap in emissions, and a sensitivity analysis found reusable oximeters only need to be used 2.3 times before they match the emissions created by a single disposable oximeter. Use phases associated with the greatest emissions varied between oximeters, with the cleaning phase of reusables responsible for the majority of its GHG emissions (99%) compared to the production phases of the single-use oximeter (74%). Conclusion Reusable pulse oximeters generated fewer greenhouse gas emissions per day of use than their disposable counterparts. Given that the pulse oximeter is an ubiquitous piece of medical equipment used in emergency care globally, carbon emissions could be significantly reduced if EDs used reusable rather than single-use, disposable oximeters.
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Affiliation(s)
- Juliana Duffy
- University of Toronto, Temerty Faculty of Medicine, Division of Emergency Medicine, Toronto, Ontario, Canada
| | - Jonathan E. Slutzman
- Massachusetts General Hospital, Center for the Environment and Health, Department of Emergency Medicine, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Meghan Landes
- University of Toronto, Temerty Faculty of Medicine, Division of Community and Family Medicine, Toronto, Ontario, Canada
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Bouvet L, Chasseigne V, Bonnet L, d'Aranda E, Zieleskiewicz L. Sustainability in anesthesia and critical care: Achievements, needs and barriers. Anaesth Crit Care Pain Med 2023; 42:101297. [PMID: 37597838 DOI: 10.1016/j.accpm.2023.101297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Lionel Bouvet
- Department of Anesthesiology and Critical Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France; APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France.
| | - Virginie Chasseigne
- Department of Pharmacy, Nîmes University Hospital, University of Montpellier, Nîmes, France; Institute Desbrest of Epidemiology and Public Health, INSERM, University Montpellier, Montpellier, France
| | - Laure Bonnet
- Department of Anesthesiology and Critical Care, Centre Hospitalier Princesse Grace, Monaco; French Society of Anesthesiology and Intensive Care (SFAR) Sustainable Development Committee, Paris, France
| | - Erwan d'Aranda
- French Society of Anesthesiology and Intensive Care (SFAR) Sustainable Development Committee, Paris, France; Intensive Care Unit, Sainte-Anne Military Teaching Hospital, Toulon, France
| | - Laurent Zieleskiewicz
- Department of Anesthesiology and Critical Care, Hôpital Nord, AP-HM, Aix Marseille Université, C2VN, Marseille, France
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Agarwal D, Bharani T, Armand W, Slutzman JE, Mullen JT. Reusable scrub caps are cost-effective and help reduce the climate footprint of surgery. Langenbecks Arch Surg 2023; 408:358. [PMID: 37707671 DOI: 10.1007/s00423-023-03107-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/10/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND As the US healthcare sector contributes to 5-10% of national CO2 emissions, with a substantial contribution from surgical services, a collective effort is important to minimize the climate footprint of surgery. Solid plastic waste generated from single-use items in operating rooms is a major contributor to greenhouse gas emissions. To address this problem, we implemented a pilot study to replace single-use scrub caps with reusable caps. METHODS Ninety-two surgical trainees at the Massachusetts General Hospital, Boston, were provided reusable personalized scrub caps. Over 6 months, their use of the reusable cap was compared with corresponding use of disposable single-use caps. We then used the cost of raw materials, fabric and cap manufacturing, transportation, and end-of-life/waste treatment to perform an economic and environmental burden analysis. RESULTS After 6 months of reusable scrub cap use, 33 participants (51.6%) reported that due to their use of a reusable scrub cap, their utilization of disposable bouffant or caps had decreased by 76-100%. This was associated with a significant reduction in the use of single-use caps after adjusting for surgical case volume. The carbon footprint of single-use scrub caps was significantly higher than reusable caps during the study period. Reusable scrub cap usage also strongly correlated with substantial reductions in energy consumption and freshwater toxicity. CONCLUSIONS Reusable personalized cloth scrub caps are cost-effective and can help reduce surgery's carbon footprint by reducing waste generated from disposable scrub cap use. More programs should consider replacing single-use polypropylene caps with reusable scrub caps for their operating room staff.
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Affiliation(s)
- Divyansh Agarwal
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA.
| | - Tina Bharani
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Wynne Armand
- Center for the Environment and Health, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Jonathan E Slutzman
- Center for the Environment and Health, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA.
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Andrieu B, Marrauld L, Vidal O, Egnell M, Boyer L, Fond G. Health-care systems' resource footprints and their access and quality in 49 regions between 1995 and 2015: an input-output analysis. Lancet Planet Health 2023; 7:e747-e758. [PMID: 37673545 PMCID: PMC10495829 DOI: 10.1016/s2542-5196(23)00169-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 07/15/2023] [Accepted: 07/16/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Strategies to reduce the environmental impact of health care are often limited to greenhouse gas emissions. To broaden their scope, our aim was to determine the evolution of the resource footprints, dependency, and efficiency of health-care systems and to determine the relationship between this evolution and their Healthcare Access and Quality (HAQ) index. METHODS We carried out an input-output analysis of 49 health-care systems from 1995 to 2015. We harmonised the EXIOBASE v3.8.2 database-providing data for 49 world regions-to the World Health Organization Health Expenditures Database. We then performed a panel data analysis to understand the relationship between Healthcare Access and Quality index and energy footprint per capita of health-care systems. EXIOBASE3 does not provide measurement errors so it was not possible to propagate the uncertainties as can be done with other input-output databases. FINDINGS Health-care systems' footprint increased over the past two decades, reaching 7% of global non-metallic minerals footprint, 4% of global metal ores footprint, and 5% of global fossil fuels footprint in 2013. This increase was mostly due to China, rising from 7% of the non-metallic minerals footprint in 1995 to 45% in 2013. 80% of the health-care systems studied were dependent at more than 50% on fossil fuel imports. The energy footprint per capita was correlated exponentially with the HAQ index but some countries performed much better than others at a given energy footprint. Health-care systems have not become more efficient between 2002 and 2015. INTERPRETATION Health-care systems' resources footprint are exponentially linked to their HAQ. Both prevention and efficiency measures will be needed to change this relationship. If it is not enough, high-income countries will have to choose between further reducing the resource consumption of their health-care systems or shifting the efforts to other sectors, health being considered an incompressible need. We call for the creation of a HAQE (health-care access, quality, and efficiency) index that would add resource efficiency to access and quality when ranking health-care systems. FUNDING The Shift Project.
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Affiliation(s)
- Baptiste Andrieu
- Institut de Sciences de la Terre (ISTerre), CNRS-University of Grenoble, Grenoble, France; The Shift Project, Paris, France.
| | - Laurie Marrauld
- The Shift Project, Paris, France; Université Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS (Recherche sur les Services et Management en Santé)-U 1309, Rennes, France
| | - Olivier Vidal
- Institut de Sciences de la Terre (ISTerre), CNRS-University of Grenoble, Grenoble, France
| | - Mathis Egnell
- P4H Network-World Health Organization, Geneva, Switzerland
| | - Laurent Boyer
- Faculté des sciences médicales et paramédicales, AP-HM, Aix-Marseille Université, Marseille, France; CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Marseille, France; Fondation FondaMental, Créteil, France
| | - Guillaume Fond
- Faculté des sciences médicales et paramédicales, AP-HM, Aix-Marseille Université, Marseille, France; CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Marseille, France; Fondation FondaMental, Créteil, France
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Gagné M, Karanikas A, Green S, Gupta S. Reductions in inhaler greenhouse gas emissions by addressing care gaps in asthma and chronic obstructive pulmonary disease: an analysis. BMJ Open Respir Res 2023; 10:e001716. [PMID: 37730281 PMCID: PMC10510936 DOI: 10.1136/bmjresp-2023-001716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/04/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Climate change from greenhouse gas (GHG) emissions represents one of the greatest public health threats of our time. Inhalers (and particularly metred-dose inhalers (MDIs)) used for asthma and chronic obstructive pulmonary disease (COPD), constitute an important source of GHGs. In this analysis, we aimed to estimate the carbon footprint impact of improving three distinct aspects of respiratory care that drive avoidable inhaler use in Canada. METHODS We used published data to estimate the prevalence of misdiagnosed disease, existing inhaler use patterns, medication class distributions, inhaler type distributions and GHGs associated with inhaler actuations, to quantify annual GHG emissions in Canada: (1) attributable to asthma and COPD misdiagnosis; (2) attributable to overuse of rescue inhalers due to suboptimally controlled symptoms; and (3) avoidable by switching 25% of patients with existing asthma and COPD to an otherwise comparable therapeutic option with a lower GHG footprint. RESULTS We identified the following avoidable annual GHG emissions: (1) ~49 100 GHG metric tons (MTs) due to misdiagnosed disease; (2) ~143 000 GHG MTs due to suboptimal symptom control; and (3) ~262 100 GHG MTs due to preferential prescription of strategies featuring MDIs over lower-GHG-emitting options (when 25% of patients are switched to lower GHG alternatives). Combined, the GHG emission reductions from bridging these gaps would be the equivalent to taking ~101 100 vehicles off the roads each year. CONCLUSIONS Our analysis shows that the carbon savings from addressing misdiagnosis and suboptimal disease control are comparable to those achievable by switching one in four patients to lower GHG-emitting therapeutic strategies. Behaviour change strategies required to achieve and sustain delivery of evidence-based real-world care are complex, but the added identified incentive of carbon footprint reduction may in itself prove to be a powerful motivator for change among providers and patients. This additional benefit can be leveraged in future behaviour change interventions.
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Affiliation(s)
- Myriam Gagné
- Division of Respirology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Aliki Karanikas
- Division of Respirology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Samantha Green
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samir Gupta
- Division of Respirology, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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Sillcox R, Blaustein M, Khandelwal S, Bryant MK, Zhu J, Chen JY. Telemedicine Use Decreases the Carbon Footprint of the Bariatric Surgery Preoperative Evaluation. Obes Surg 2023; 33:2527-2532. [PMID: 37407773 DOI: 10.1007/s11695-023-06721-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Healthcare-associated activity accounts for 10% of the United States' carbon dioxide (CO2) emissions. Using telemedicine for bariatric surgery evaluations decreases emissions and reduces patient burden during the multiple required interdisciplinary visits. After adopting telemedicine during COVID, our clinic continues to utilize telemedicine for preoperative bariatric evaluations. We evaluated the reduced environmental impact associated with this practice. METHODS A retrospective review of all new evaluations for vertical sleeve gastrectomy (SG) or Roux-en Y gastric bypass (RYGB) from 2019 and 2021 was conducted. The 2019 year represents pre-pandemic, in-person evaluations and 2021 represents telemedicine evaluations during the COVID pandemic. Carbon emissions were calculated using the Environmental Protection Agency's (EPA's) validated formula of 404g CO2 per car-mile. Preoperative evaluation time was calculated from the initial clinic visit to the operation date. RESULTS There were 51 patients in the 2019 cohort and 55 patients in the 2021 cohort. In the 2019 in-person cohort, there was significantly more kg of estimated CO2 emitted (10,225 vs. 2011.4, p<.001) compared to the 2021 cohort. For time required to complete the preoperative workup, there was no statistically significant difference between the two groups (162 days vs. 193 days, p=.226). The attrition rate was lower in the 2021 cohort (22.22% v. 35.9%, p<.001). CONCLUSIONS Implementation of telemedicine for bariatric preoperative evaluations reduced patient travel, carbon emissions, and improved attrition rate. We encourage bariatric providers to use telemedicine as we believe this eases patient burdens and, with wider adoption, could significantly reduce our carbon footprint.
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Affiliation(s)
- Rachel Sillcox
- Department of Surgery, University of Washington, 1959 NE Pacific Street Box 356410, Seattle, WA, 98195, USA.
| | - Megan Blaustein
- Department of Surgery, University of Washington, 1959 NE Pacific Street Box 356410, Seattle, WA, 98195, USA
| | - Saurabh Khandelwal
- Department of Surgery, University of Washington, 1959 NE Pacific Street Box 356410, Seattle, WA, 98195, USA
| | - Mary Kate Bryant
- Department of Surgery, University of Washington, 1959 NE Pacific Street Box 356410, Seattle, WA, 98195, USA
| | - Jay Zhu
- Department of Surgery, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Judy Y Chen
- Department of Surgery, University of Washington, 1959 NE Pacific Street Box 356410, Seattle, WA, 98195, USA
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Spoyalo K, Lalande A, Rizan C, Park S, Simons J, Dawe P, Brown CJ, Lillywhite R, MacNeill AJ. Patient, hospital and environmental costs of unnecessary bloodwork: capturing the triple bottom line of inappropriate care in general surgery patients. BMJ Open Qual 2023; 12:e002316. [PMID: 37402596 DOI: 10.1136/bmjoq-2023-002316] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/26/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE To characterise the extent of unnecessary care in general surgery inpatients using a triple bottom line approach. DESIGN Patients with uncomplicated acute surgical conditions were retrospectively evaluated for unnecessary bloodwork according to the triple bottom line, quantifying the impacts on patients, healthcare costs and greenhouse gas emissions. The carbon footprint of common laboratory investigations was estimated using PAS2050 methodology, including emissions generated from the production, transport, processing and disposal of consumable goods and reagents. SETTING Single-centre tertiary care hospital. PARTICIPANTS Patients admitted with acute uncomplicated appendicitis, cholecystitis, choledocholithiasis, gallstone pancreatitis and adhesive small bowel obstruction were included in the study. 304 patients met inclusion criteria and 83 were randomly selected for in-depth chart review. MAIN OUTCOME MEASURES In each patient population, the extent of over-investigation was determined by comparing ordered laboratory investigations against previously developed consensus recommendations. The quantity of unnecessary bloodwork was measured by number of phlebotomies, tests and blood volume in addition to healthcare costs and greenhouse gas emissions. RESULTS 76% (63/83) of evaluated patients underwent unnecessary bloodwork resulting in a mean of 1.84 phlebotomies, 4.4 blood vials, 16.5 tests and 18 mL of blood loss per patient. The hospital and environmental cost of these unnecessary activities was $C5235 and 61 kg CO2e (974 g CO2e per person), respectively. The carbon footprint of a common set of investigations (complete blood count, differential, creatinine, urea, sodium, potassium) was 332 g CO2e. Adding a liver panel (liver enzymes, bilirubin, albumin, international normalised ratio/partial thromboplastin time) resulted in an additional 462 g CO2e. CONCLUSIONS We found considerable overuse of laboratory investigations among general surgery patients admitted with uncomplicated acute surgical conditions resulting in unnecessary burden to patients, hospitals and the environment. This study identifies an opportunity for resource stewardship and exemplifies a comprehensive approach to quality improvement.
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Affiliation(s)
- Karina Spoyalo
- Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Annie Lalande
- Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Chantelle Rizan
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Sophia Park
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Janet Simons
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Philip Dawe
- Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Carl J Brown
- Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Lillywhite
- School of Life Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrea J MacNeill
- Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
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Taboun OS, Orr SMA, Pereira A, Choudhry N. Factors contributing to the carbon footprint of cataract surgery. J Cataract Refract Surg 2023; 49:759-763. [PMID: 37390323 DOI: 10.1097/j.jcrs.0000000000001204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/13/2023] [Indexed: 07/02/2023]
Abstract
The healthcare sector is a significant greenhouse gas emitter. Cataract surgery is a procedure that results in a large amount of carbon dioxide (CO2) emissions. We sought to review the literature for factors contributing to the carbon footprint of this procedure. The literature, although limited, varies greatly by region. The carbon footprint of cataract surgery ranged from approximately 6 kg CO2 equivalents in a center in India to 181.9 kg CO2 equivalents in a center in the United Kingdom. Factors contributing to the carbon footprint of cataract surgery included the procurement of materials, energy use, and the emissions associated with travel. Factors facilitating a lower carbon footprint include the reuse of surgical materials and more efficient autoclave settings. Potential areas for improvement to consider include the reduction in packaging material, the reuse of materials, and potentially reducing travel emissions by performing simultaneous bilateral cataract surgery.
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Affiliation(s)
- Omar Salem Taboun
- From the Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada (Taboun); Vitreous Retina Macula Specialists of Toronto, Toronto, Ontario, Canada (Orr, Choudhry); Octane Imaging Lab, Toronto, Ontario, Canada (Orr, Pereira, Choudhry); Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario Canada (Pereira, Choudhry)
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Sulbaek Andersen MP, Nielsen OJ, Sherman JD. Assessing the potential climate impact of anaesthetic gases. Lancet Planet Health 2023; 7:e622-e629. [PMID: 37438003 DOI: 10.1016/s2542-5196(23)00084-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 07/14/2023]
Abstract
There is increasing concern within the health-care community about the role care delivery plays in environmental degradation, sparking research into how to reduce pollution from clinical practice. Inhaled anaesthetics is a particular research area of interest for two reasons. First, several gases are potent greenhouse gases, and waste gas is mostly emitted directly to the environment. Second, there are options to reduce gas waste and substitute medications and procedures with fewer embodied emissions while delivering high-quality care. Performance improvements are contingent on a proper understanding of the emission estimates and climate metrics used to ensure consistent application in guiding mitigation strategies and accounting at various scales. We review the current literature on the environmental impact and the estimation of the potential climate forcing of common inhaled anaesthetic drugs: desflurane, sevoflurane, isoflurane, methoxyflurane, and nitrous oxide.
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Affiliation(s)
- Mads Peter Sulbaek Andersen
- Department of Chemistry and Biochemistry, California State University Northridge, Northridge, CA, USA; Copenhagen Center for Atmospheric Research, Department of Chemistry, University of Copenhagen, Copenhagen, Denmark.
| | - Ole John Nielsen
- Copenhagen Center for Atmospheric Research, Department of Chemistry, University of Copenhagen, Copenhagen, Denmark
| | - Jodi D Sherman
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
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Lakatos K, Teherani A, Thottathil SE, Gandhi S, Weiser SD, Brindis CD. A race to net zero-early lessons from healthcare's decarbonization marathon. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad006. [PMID: 38770407 PMCID: PMC11103727 DOI: 10.1093/haschl/qxad006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/16/2023] [Indexed: 05/22/2024]
Abstract
Climate change poses a threat to healthcare systems; at the same time, healthcare systems contribute to a worsening climate. Climate-induced disasters are predicted to increase both the demand for healthcare services while also posing a threat to the integrity of healthcare systems' infrastructures and supply chains. Many healthcare organizations have taken initiatives to prepare for such disasters through implementing carbon emission-reduction practices and infrastructure reinforcement, through globally recognized frameworks and strategies known as Scopes 1, 2, and 3, and decarbonization. We explored the efforts of these early adopters to understand how they are thinking about and addressing climate change's impacts on healthcare. Through a process of reviewing the peer-reviewed literature, publicly available published documents, annual sustainability reports, conference presentations, and participation in a national decarbonization collaborative, we (1) provide a diverse set of examples showcasing the variety of ways healthcare systems are responding; (2) identify a set of emergent key themes to implementing decarbonization practices, such as the role of an organizational culture of iterative improvement and building systems of cross-organizational collaboration; and (3) synthesize the identifiable set of driving factors for long-term sustainability of these decarbonization efforts.
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Affiliation(s)
- Kyle Lakatos
- School of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
- Harvard Kennedy School of Government, Cambridge, MA 02138, United States
| | - Arianne Teherani
- School of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
- UC Center for Climate, Health, and Equity, University of California, CA, United States
| | - Sapna E Thottathil
- UC Center for Climate, Health, and Equity, University of California, CA, United States
| | - Seema Gandhi
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA 94143, United States
- University of California, San Francisco, San Francisco, CA 94143, United States
| | - Sheri D Weiser
- School of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
- UC Center for Climate, Health, and Equity, University of California, CA, United States
| | - Claire D Brindis
- UC Center for Climate, Health, and Equity, University of California, CA, United States
- University of California, San Francisco, San Francisco, CA 94143, United States
- Philip R. Lee Institute for Health Policy Studies, San Francisco, CA 94158, United States
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Soares AL, Buttigieg SC, Bak B, McFadden S, Hughes C, McClure P, Couto JG, Bravo I. A Review of the Applicability of Current Green Practices in Healthcare Facilities. Int J Health Policy Manag 2023; 12:6947. [PMID: 37579377 PMCID: PMC10461902 DOI: 10.34172/ijhpm.2023.6947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/19/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Circular economy (CE) has raised great interest as a concept and as a development model worldwide. This concept aims to provide a substitute for the linear economic model, which was based on production and consumption, continuous growth, and resources depletion. CE allows a greener economy with sustainable development and promotes more balanced societies. The healthcare sector is a major contributor to the climate crisis, with a carbon footprint representing 4.4% of global net emissions. It is thus essential to rethink the applicability of CE in healthcare. METHODS We conducted a scoping review guided by the Arksey and O'Malley methodological framework and utilised PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist. A systematic search from MEDLINE complete, SCOPUS, and Web of Science databases published between 1992 and 2022. RESULTS Through database searching a total of 1018 records were identified and 475 duplicates were removed. From the total search, 543 articles were screened by title/abstract according to the inclusion and exclusion criteria. After screening, 38 full-text articles were selected and assessed for eligibility. Forty-seven additional records were also identified through other sources and screened for eligibility. Other sources included: 12 articles from snowballing of previous papers; 9 articles following peer-reviewers suggestions; 19 reports from relevant organisations in CE and healthcare; two webpage, and one book. CONCLUSION Specific areas were identified where hospitals could reduce their greenhouse gas (GHG) emissions and consequently their negative environmental impact, namely through waste management, energy, water, transportation/travel, hospital design, food optimisation, green procurement, and behaviour. Also, lack of staff awareness and knowledge of the environmental impact of healthcare, and hospitals sustainability were identified as major contributors.
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Affiliation(s)
- Ana Luísa Soares
- Medical Physics Service, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Sandra C. Buttigieg
- Department of Health Systems Management and Leadership, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Bartosz Bak
- Radiotherapy Department II, Greater Poland Cancer Center, Poznan, Poland
- Department of Electroradiology, University of Medical Science, Poznan, Poland
| | - Sonya McFadden
- Faculty of Life and Health Sciences, Ulster University, Newtownabbey, UK
| | - Ciara Hughes
- Faculty of Life and Health Sciences, Ulster University, Newtownabbey, UK
| | - Patricia McClure
- Faculty of Life and Health Sciences, Ulster University, Newtownabbey, UK
| | - Jose Guilherme Couto
- Radiography Department, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Isabel Bravo
- Medical Physics and Radiobiology Group, Research Center (IPOP), Portuguese Oncology Institute of Porto, Porto, Portugal
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Winklmair N, Kieselbach G, Bopp J, Amon M, Findl O. Potential environmental effect of reducing the variation of disposable materials used for cataract surgery. J Cataract Refract Surg 2023; 49:628-634. [PMID: 36806589 DOI: 10.1097/j.jcrs.0000000000001170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To analyze the cataract package variability in 1 country, Austria. SETTING Austrian Departments of Ophthalmology. DESIGN Cross-sectional study. METHODS The cataract package components of 3 different Austrian hospitals were weighed and life cycle assessment on each product performed. This data was then extrapolated to the sales figures of the main Austrian cataract package suppliers to estimate the carbon footprint of all cataract packages used in Austria in 2021. RESULTS There were 55 different cataract package compositions in use with an average weight of 0.7 kg. These compositions differ significantly in weight and composition considering that the smallest package was 57% lighter than the largest package. The size of the surgical drapes also showed considerable variation, with a difference of up to 71%. This is substantial, considering that drapes and covers account for about 53% of the package weight. CONCLUSIONS There was a considerable variation in package composition and product size, which could provide opportunities to save carbon dioxide emissions in cataract surgery. If all Austrian eye departments were to reduce the material quantities and drape sizes to the lower third of the cataract packages used in the Austria in 2021, cataract package associated CO 2 emissions could be reduced by 34%.
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Affiliation(s)
- Nicolas Winklmair
- From the Vienna Institute for Research in Ocular Surgery (VIROS), A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria (Winklmair, Findl); Department of Ophthalmology, Medical University Innsbruck, Innsbruck, Austria (Kieselbach); Sphera Solutions GmbH, Leinfelden-Echterdingen, Austria (Bopp); Academic Hospital St. John, Vienna, Austria (Amon); Sigmund Freud Private University, Vienna, Austria (Amon)
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Sillcox R, Gitonga B, Meiklejohn DA, Wright AS, Oelschlager BK, Bryant MK, Tarefder R, Khan Z, Zhu J. The environmental impact of surgical telemedicine: life cycle assessment of virtual vs. in-person preoperative evaluations for benign foregut disease. Surg Endosc 2023:10.1007/s00464-023-10131-9. [PMID: 37237107 DOI: 10.1007/s00464-023-10131-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Health care accounts for almost 10% of the United States' greenhouse gas emissions, accounting for a loss of 470,000 disability-adjusted life years based on the health effects of climate change. Telemedicine has the potential to decrease health care's carbon footprint by reducing patient travel and clinic-related emissions. At our institution, telemedicine visits for evaluation of benign foregut disease were implemented for patient care during the COVID-19 pandemic. We aimed to estimate the environmental impact of telemedicine usage for these clinic encounters. METHODS We used life cycle assessment (LCA) to compare greenhouse gas (GHG) emissions for an in-person and a telemedicine visit. For in-person visits, travel distances to clinic were retrospectively assessed from 2020 visits as a representative sample, and prospective data were gathered on materials and processes related to in-person clinic visits. Prospective data on the length of telemedicine encounters were collected and environmental impact was calculated for equipment and internet usage. Upper and lower bounds scenarios for emissions were generated for each type of visit. RESULTS For in-person visits, 145 patient travel distances were recorded with a median [IQR] distance travel distance of 29.5 [13.7, 85.1] miles resulting in 38.22-39.61 carbon dioxide equivalents (kgCO2-eq) emitted. For telemedicine visits, the mean (SD) visit time was 40.6 (17.1) min. Telemedicine GHG emissions ranged from 2.26 to 2.99 kgCO2-eq depending on the device used. An in-person visit resulted in 25 times more GHG emissions compared to a telemedicine visit (p < 0.001). CONCLUSION Telemedicine has the potential to decrease health care's carbon footprint. Policy changes to facilitate telemedicine use are needed, as well as increased awareness of potential disparities of and barriers to telemedicine use. Moving toward telemedicine preoperative evaluations in appropriate surgical populations is a purposeful step toward actively addressing our role in health care's large carbon footprint.
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Affiliation(s)
- Rachel Sillcox
- Department of Surgery, University of Washington, 1318 22nd St NW, Seattle, WA, 20037, USA.
| | - Baraka Gitonga
- Department of Surgery, University of Washington, 1318 22nd St NW, Seattle, WA, 20037, USA
| | - Duncan A Meiklejohn
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Andrew S Wright
- Department of Surgery, University of Washington, 1318 22nd St NW, Seattle, WA, 20037, USA
| | - Brant K Oelschlager
- Department of Surgery, University of Washington, 1318 22nd St NW, Seattle, WA, 20037, USA
| | - Mary Kate Bryant
- Department of Surgery, University of Washington, 1318 22nd St NW, Seattle, WA, 20037, USA
| | - Rafiqul Tarefder
- Department of Civil, Construction and Environmental Engineering, University of New Mexico, Albuquerque, NM, USA
| | - Zafrul Khan
- Department of Civil, Construction and Environmental Engineering, University of New Mexico, Albuquerque, NM, USA
| | - Jay Zhu
- Department of Surgery, University of New Mexico Hospital, Albuquerque, NM, USA
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Hensher M. Climate change, health and sustainable healthcare: The role of health economics. HEALTH ECONOMICS 2023; 32:985-992. [PMID: 36701185 DOI: 10.1002/hec.4656] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/02/2022] [Accepted: 01/16/2023] [Indexed: 06/17/2023]
Abstract
Healthcare systems around the world are responding with increasing urgency to rapidly evolving ecological crises, most notably climate change. This Perspective considers how health economics and health economists can best contribute to protecting health and building sustainable healthcare systems in the face of these challenges.
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Affiliation(s)
- Martin Hensher
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Green S, Labine N, Luo OD, Vipond J, Moloo H, Bouka A, Thoma B. Planetary Health in CanMEDS 2025. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:46-49. [PMID: 36998490 PMCID: PMC10042797 DOI: 10.36834/cmej.75438] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | | | | | | | | | - Aimee Bouka
- University of Toronto, Ontario, Canada
- University of Saskatchewan, Saskatchewan, Canada
- McGill University, Quebec, Canada
- University of Calgary, Alberta, Canada
- University of Ottawa, Ontario, Canada
| | - Brent Thoma
- University of Saskatchewan, Saskatchewan, Canada
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Ip VHY, Shelton CL, Zimmermann GL. Promoting practice change towards environmentally sustainable health care: more than meets the eye. Can J Anaesth 2023; 70:295-300. [PMID: 36765013 DOI: 10.1007/s12630-022-02391-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/02/2022] [Accepted: 12/11/2022] [Indexed: 02/12/2023] Open
Affiliation(s)
- Vivian H Y Ip
- Department of Anesthesiology & Pain Medicine, University of Alberta, University of Alberta Hospital, 2-150 Clinical Sciences Building (CSB), 8440 112 St NW, Edmonton, AB, T6G 2G3, Canada.
| | - Clifford L Shelton
- Department of Anaesthesia, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Gabrielle L Zimmermann
- Alberta SPOR SUPPORT Unit - Learning Health System Team, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Davies JF, McGain F, Francis JJ. Consensus on Prioritisation of Actions for Reducing the Environmental Impact of a Large Tertiary Hospital: Application of the Nominal Group Technique. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3978. [PMID: 36901002 PMCID: PMC10001469 DOI: 10.3390/ijerph20053978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Hospitals are the largest greenhouse gas producers within the Australian healthcare sector due to the large amounts of energy, resource utilization, equipment and pharmaceuticals required to deliver care. In order to reduce healthcare emissions, healthcare services must take multiple actions to address the broad range of emissions produced when delivering patient care. The goal of this study was to seek consensus on the priority actions needed to reduce the environmental impact of a tertiary Australian hospital. A nominal group technique was utilized within a multidisciplinary, executive-led environmental sustainability committee to find consensus on the 62 proposed actions to reduce the environmental impact of a tertiary Australian hospital. Thirteen participants joined an online workshop during which an educational presentation was delivered, 62 potential actions were privately ranked according to two domains of 'amenability to change' and 'scale of climate impact' and a moderated group discussion ensued. The group achieved verbal consensus on 16 actions that span staff education, procurement, pharmaceuticals, waste, transport and advocacy on all-electric capital works upgrades. In addition, the individual ratings of potential actions according to each domain were ranked and shared with the group. Despite a large number of actions and varied perspectives within the group, the nominal group technique can be used to focus a hospital leadership group on priority actions to improve environmental sustainability.
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Affiliation(s)
- Jessica F. Davies
- Anaesthetics Department, Austin Health, Heidelberg, VIC 3084, Australia
- Department of Critical Care, School of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | - Forbes McGain
- Department of Critical Care, School of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
- Anaesthetic and Intensive Care Departments, Western Health, St Albans, VIC 3021, Australia
- School of Public Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Jillian J. Francis
- School of Health Sciences, University of Melbourne, Melbourne, VIC 3010, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, 305 Grattan St., Melbourne, VIC 3000, Australia
- Centre for Implementation Research, Ottawa Hospital Research Institute, General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
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Greener Gases Starter Pack: a tool for transitioning to more sustainable anesthetic volatile agents. Can J Anaesth 2023; 70:445-446. [PMID: 36814056 DOI: 10.1007/s12630-022-02394-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/17/2022] [Accepted: 05/30/2022] [Indexed: 02/24/2023] Open
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Mathers A, Fan S, Austin Z. Climate change at a crossroads: Embedding environmental sustainability into the core of pharmacy education. Can Pharm J (Ott) 2023; 156:55-59. [PMID: 36969305 PMCID: PMC10034526 DOI: 10.1177/17151635231152882] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/07/2022] [Indexed: 02/18/2023]
Affiliation(s)
- Annalise Mathers
- University of Toronto, Leslie L. Dan Faculty of Pharmacy, Toronto
| | - Shirley Fan
- University of Toronto, Leslie L. Dan Faculty of Pharmacy, Toronto
- University of Waterloo, School of Pharmacy, Waterloo, Ontario
| | - Zubin Austin
- University of Toronto, Leslie L. Dan Faculty of Pharmacy, Toronto
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Furlan L, Di Francesco P, Tobaldini E, Solbiati M, Colombo G, Casazza G, Costantino G, Montano N. The environmental cost of unwarranted variation in the use of magnetic resonance imaging and computed tomography scans. Eur J Intern Med 2023; 111:47-53. [PMID: 36759306 DOI: 10.1016/j.ejim.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Pollution is a major threat to global health, and there is growing interest on strategies to reduce emissions caused by health care systems. Unwarranted clinical variation, i.e. variation in the utilization of health services unexplained by differences in patient illness or preferences, may be an avoidable source of CO2 when related to overuse. Our objective was to evaluate the CO2 emissions attributable to unwarranted variation in the use of MRI and CT scans among countries of the G20-area. METHODS We selected seven countries of the G20-area with available data on the use of CT and MRI scans from the organization for Economic Co-operation and Development repository. Each nation's annual electric energy expenditure per 1000 inhabitants for such exams (T-Enex-1000) was calculated and compared with the median and lowest value. Based on such differences we estimated the national energy and corresponding tons of CO2 that could be potentially avoided each year. RESULTS With available data we found a significant variation in T-Enex-1000 (median value 1782 kWh, range 1200-3079 kWh) and estimated a significant amount of potentially avoidable emissions each year (range 2046-175120 tons of CO2). In practical terms such emissions would need, in the case of Germany, 71900 and 104210 acres of forest to be cleared from the atmosphere, which is 1.2 and 1.7 times the size of the largest German forest (Bavarian National Forest). CONCLUSION Among countries with a similar rate of development, unwarranted clinical variation in the use of MRI and CT scan causes significant emissions of CO2.
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Affiliation(s)
- Ludovico Furlan
- Department of Internal Medicine, General Medicine Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Pietro Di Francesco
- Department of Internal Medicine, General Medicine Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleonora Tobaldini
- Department of Internal Medicine, General Medicine Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Monica Solbiati
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Department of Anaesthesia and Intensive Care Unit, Emergency Department and Emergency Medicine Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Colombo
- Department of Anaesthesia and Intensive Care Unit, Emergency Department and Emergency Medicine Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Casazza
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giorgio Costantino
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Department of Anaesthesia and Intensive Care Unit, Emergency Department and Emergency Medicine Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Montano
- Department of Internal Medicine, General Medicine Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
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Wicklum SC, Nuique K, Kelly MA, Nesbitt CC, Zhang JJ, Svrcek CP. Greening Family Medicine clinic operations and clinical care, where do we start? A scoping review of toolkits and aids. Fam Pract 2023; 40:473-485. [PMID: 36730055 DOI: 10.1093/fampra/cmad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND There is a pressing need for healthcare to respond to the climate crisis. Family physicians, given their central role in community healthcare provision, are strategically placed to lead, support, and promote sustainable healthcare, yet guidance on how to do this is fragmented. OBJECTIVE To identify and evaluate toolkits and aids on sustainable healthcare to act as a curated resource for family physicians and their care teams interested in delivering evidence-based sustainable healthcare in their clinical practices. METHODS A scoping review was completed of the published and grey literature across 4 databases and 2 search engines to identify articles and aids/toolkits from 1990 to present. Toolkits were subsequently evaluated for purpose, evidence-base, implementation process, adaptability to family medicine, and outcome measures. RESULTS The search identified 17,751 articles. Screening resulted in 20 published articles and 11 toolkits. Most articles presented simple checklists to support greening clinic initiatives, 3 studies focussed on partial carbon footprint analyses, and 4 on educational initiatives. Toolkits ranged in sustainability topics and degree of depth covered, and adaptability and outcome measures. None of the resources identified have been formally evaluated for effectiveness. CONCLUSIONS A range of aids exist to support greening of clinic operations; however, there is a significant gap in the literature for greening clinical care. Two toolkits were found to be comprehensive, one requiring tracking and reporting of sustainability initiatives. This scoping review provides a starting point for motivated family doctors and community clinics to initiate change and support more sustainable healthcare.
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Affiliation(s)
- Sonja C Wicklum
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Kate Nuique
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Martina A Kelly
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Colleen C Nesbitt
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Jessica J Zhang
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Clark P Svrcek
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
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Luo OD, Razvi Y, Kaur G, Lim M, Smith K, Carson JJK, Petrin-Desrosiers C, Haldane V, Simms N, Miller FA. A qualitative study of what motivates and enables climate-engaged physicians in Canada to engage in health-care sustainability, advocacy, and action. Lancet Planet Health 2023; 7:e164-e171. [PMID: 36754472 DOI: 10.1016/s2542-5196(22)00311-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 06/18/2023]
Abstract
Increasing numbers of health-care professionals are aware of the need to deliver low-carbon sustainable health systems. We aimed to explore how physicians can be motivated and supported to pursue this ambition by conducting an exploratory qualitative descriptive study that involved individual in-depth interviews with climate-engaged Canadian physicians participating in health-care sustainability advocacy and action. Interview transcripts were analysed to identify themes related to the actions that physicians can take to promote sustainable health care, and the motivators and enablers of physician engagement in sustainable health care. Participants (n=19) engaged in a spectrum of health-care sustainability initiatives ranging from reducing health-care waste to lobbying and political action. They were motivated to advance health-care sustainability by their concern about the health implications of climate change, frustration with health-care waste, and recognition of their locus of influence as physicians. Participants articulated that policy and system, organisational and team, and knowledge generation and translation supports are required to strengthen their capacity to advance health-care sustainability. These findings can provide inspiration for engagement opportunities in health-care sustainability, guide service delivery and educational innovations to promote health-care professionals' interest in becoming sustainability champions, and extend the capacity of health-care professionals to reduce the climate impact of health care.
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Affiliation(s)
- Owen Dan Luo
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, QC, Canada
| | - Yasmeen Razvi
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gurleen Kaur
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michelle Lim
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kelti Smith
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jacob Joel Kirsh Carson
- Department of Pediatrics, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Claudel Petrin-Desrosiers
- Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Nicole Simms
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Centre for Sustainable Health Systems, University of Toronto, Toronto, ON, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Centre for Sustainable Health Systems, University of Toronto, Toronto, ON, Canada.
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Leapman MS, Thiel CL, Gordon IO, Nolte AC, Perecman A, Loeb S, Overcash M, Sherman JD. Environmental Impact of Prostate Magnetic Resonance Imaging and Transrectal Ultrasound Guided Prostate Biopsy. Eur Urol 2023; 83:463-471. [PMID: 36635108 DOI: 10.1016/j.eururo.2022.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/17/2022] [Accepted: 12/09/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Reducing low-value clinical care is an important strategy to mitigate environmental pollution caused by health care. OBJECTIVE To estimate the environmental impacts associated with prostate magnetic resonance imaging (MRI) and prostate biopsy. DESIGN, SETTING, AND PARTICIPANTS We performed a cradle-to-grave life cycle assessment of prostate biopsy. Data included materials and energy inventory, patient and staff travel contributed by prostate MRI, transrectal ultrasound guided prostate biopsy, and pathology analysis. We compared environmental emissions across five clinical scenarios: multiparametric MRI (mpMRI) of the prostate with targeted and systematic biopsies (baseline), mpMRI with targeted biopsy cores only, systematic biopsy without MRI, mpMRI with systematic biopsy, and biparametric MRI (bpMRI) with targeted and systematic biopsies. We estimated the environmental impacts associated with reducing the overall number and varying the approach of a prostate biopsy by using MRI as a triage strategy or by omitting MRI. The study involved academic medical centers in the USA, outpatient urology clinics, health care facilities, medical staff, and patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Greenhouse gas emissions (CO2 equivalents, CO2e), and equivalents of coal and gasoline burned were measured. RESULTS AND LIMITATIONS In the USA, a single transrectal prostate biopsy procedure including prostate MRI, and targeted and systematic biopsies emits an estimated 80.7 kg CO2e. An approach of MRI targeted cores alone without a systematic biopsy generated 76.2 kg CO2e, a systematic 12-core biopsy without mpMRI generated 36.2 kg CO2e, and bpMRI with targeted and systematic biopsies generated 70.5 kg CO2e; mpMRI alone contributed 42.7 kg CO2e (54.3% of baseline scenario). Energy was the largest contributor, with an estimated 38.1 kg CO2e, followed by staff travel (20.7 kg CO2e) and supply production (11.4 kg CO2e). Performing 100 000 fewer unnecessary biopsies would avoid 8.1 million kg CO2e, the equivalent of 4.1 million liters of gasoline consumed. Per 100 000 patients, the use of prostate MRI to triage prostate biopsy and guide targeted biopsy cores would save the equivalent of 1.4 million kg of CO2 emissions, the equivalent of 700 000 l of gasoline consumed. This analysis was limited to prostate MRI and biopsy, and does not account for downstream clinical management. CONCLUSIONS A prostate biopsy contributes a calculable environmental footprint. Modifying or reducing the number of biopsies performed through existing evidence-based approaches would decrease health care pollution from the procedure. PATIENT SUMMARY We estimated that prostate magnetic resonance imaging (MRI) with a prostate biopsy procedure emits the equivalent of 80.7 kg of carbon dioxide. Performing fewer unnecessary prostate biopsies or using prostate MRI as a tool to decide which patients should have a prostate biopsy would reduce procedural greenhouse gas emissions and health care pollution.
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Affiliation(s)
- Michael S Leapman
- Department of Urology, Yale School of Medicine, New Haven, CT, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
| | - Cassandra L Thiel
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA; Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA; Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | - Stacy Loeb
- Department of Urology, New York University Langone Health, New York, NY, USA; Departments of Urology and Population Health, New York University Langone Health, New York, NY, USA; Manhattan Veterans Affairs Medical Center, New York, NY, USA
| | | | - Jodi D Sherman
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
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Chambrin C, de Souza S, Gariel C, Chassard D, Bouvet L. Association Between Anesthesia Provider Education and Carbon Footprint Related to the Use of Inhaled Halogenated Anesthetics. Anesth Analg 2023; 136:101-110. [PMID: 35986678 DOI: 10.1213/ane.0000000000006172] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Inhaled halogenated anesthetics are responsible for half of operating room total greenhouse gas emissions. Sustainable anesthesia groups were set up in 4 Lyon, France, university hospitals (Hospices Civils de Lyon) in January 2018 and have supported a specific information campaign about the carbon footprint related to the use of inhaled halogenated anesthetics in June 2019. We aimed to assess whether implementing such information campaigns was associated with a decrease in the carbon footprint related to inhaled halogenated anesthetics. METHODS This retrospective cohort study was conducted from January 1, 2015, to February 29, 2020, in 4 hospitals of the Hospices Civils de Lyon in France. Information meetings on sustainable anesthesia practices were organized by sustainable anesthesia groups that were set up in January 2018. In addition, a specific information campaign about the carbon footprint related to inhaled halogenated anesthetics was conducted in June 2019; it was followed by a questionnaire to be completed online. The monthly purchase of sevoflurane, desflurane, and propofol was recorded, and the estimated monthly carbon footprint from desflurane- and sevoflurane-related perioperative emissions was calculated. The interrupted time-series data from January 2015 to February 2020 were analyzed by segmented regression, considering both interventions (setting up of the sustainable anesthesia groups and specific information campaign) in the analysis and adjusting for 2 confounding factors (seasonality of the data and number of general anesthesia uses). RESULTS Among the 641 anesthesia providers from the study hospitals, 121 (19%) attended the information meetings about the carbon footprint of inhaled halogenated anesthetics, and 180 (28%) completed the questionnaire. The anesthetic activity from all 641 providers was considered in the analysis. After the sustainable anesthesia groups were set up, the carbon footprint of sevoflurane and desflurane started decreasing: the slope significantly changed ( P < .01) and became significantly negative, from -0.27 (95% confidence interval [CI], -1.08 to 0.54) tons.month -1 to -14.16 (95% CI, -16.67 to -11.65) tons.month -1 . After the specific information campaign, the carbon footprint kept decreasing, with a slope of -7.58 (95% CI, -13.74 to -1.41) tons.month -1 ( P = .02), which was not significantly different from the previous period ( P = .07). CONCLUSIONS The setup of the sustainable anesthesia groups was associated with a dramatic reduction in the carbon footprint related to halogenated anesthetics. These results should encourage health care institutions to undertake information campaigns toward anesthesia providers so that they also take into account the environmental impact in the choice of anesthetic drugs, in addition to the benefits for the patient and economic concerns.
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Affiliation(s)
- Coralie Chambrin
- From the Department of Anesthesia and Critical Care, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Lyon, France
| | - Sander de Souza
- Department of Medical Public Health, Hospices Civils de Lyon, Lyon, France
| | - Claire Gariel
- From the Department of Anesthesia and Critical Care, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Lyon, France
| | - Dominique Chassard
- From the Department of Anesthesia and Critical Care, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Lyon, France
| | - Lionel Bouvet
- From the Department of Anesthesia and Critical Care, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Lyon, France
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