Healthcare Carbon Footprint Research Articles

Interventions to reduce low-value care in intensive care settings: a scoping review of impacts on health, resource use, costs, and the environment.

Low-value care is common in intensive care units (ICUs), unnecessarilyexposing patients to risks and harms, incuring costs to the patient and healthcare system, and contributing to healthcare's carbon footprint. We aimed to identify, collate, and summarise published evidence on the impact of interventions to reduce low-value care in ICUs. We searched MEDLINE, Embase, and Cochrane CENTRAL from inception to 22 September 2023 for evaluations of interventions aiming to reduce low-value care, supplemented by reference lists and recently published articles. We recorded impacts on the low-value target,health outcomes, resource use, cost, and the environment. From 1155 studies screened, 32 eligible studies were identified evaluating interventions toreduce: routine blood testing (n = 13), routine chest X-rays (n = 10), and other types (or multiple types) of low-value care (n = 9). All but 3 of the interventions found reductions in the immediate low-value care target (usually the primary outcome). Although the small sample size ofmost included studies, limited their ability to detect impactson other outcomes, manyinterventions were alsoassociated with improved health outcomes and financial savings. The only study that reported environmental impacts found the intervention was associated with reduced carbon dioxide equivalent (CO2-e) emissions. Interventions to reduce low-value care in ICUs may have important health, financial, and environmental co-benefits. Further research may inform wider scale-up and sustainability of successful strategies to decrease low-value healthcare. More empirical evidence on potential environmental benefits may inform policies to lower healthcare's carbon footprint.

Evaluating the carbon footprint of sedation practices in intensive care.

Healthcare's carbon footprint contributes to 4.4% of global net emissions and intensive care units (ICUs) are very resource intensive. Existing studies on environmental sustainability in ICUs focused on carbon footprint generated from energy and electricity consumption, use of medical consumables and equipment, but few studies quantified carbon footprint generated from pharmaceuticals used in ICUs. To evaluate carbon footprint arising from sedation practices in the ICUs. A pilot, prospective observational study was conducted in two ICUs from 1 August to 22 September 2022 in Singapore General Hospital. Adult patients who were consecutively sedated, intubated and expected to be mechanically ventilated for at least 24 h were included. Total amount of analgesia and sedatives used and wasted in eligible patients were collected. Carbon emission from ICU sedation practices were then quantified using available life cycle assessment data. A total of 31 patients were recruited. Top analgesia and sedative used in both ICUs were fentanyl and propofol, respectively. Carbon footprint from sedative usage and wastage across 7 weeks in both ICUs were 2.206 kg CO2-e and 0.286 g CO2-e, respectively. In total, this equates to driving 15.8 km by car. Proportion of drug wasted ranged from 5.1% to 25.0%, with the top reason for wastage being the drug was no longer clinically indicated. Recommendations to reduce carbon footprint include choosing sedatives with lower carbon emissions where possible and having effective communication among doctors and nurses regarding management plans to minimize unnecessary wastage. Our study quantified carbon footprint arising from sedation practices, mainly drug usage and wastage in two ICUs in Singpore General Hospital. Adopting a holistic approach to environmental sustainability in the ICU, sedation practices also contribute to generating greenhouse gases, albeit small, and can be targeted to reduce unnecessary carbon footprint.

Evaluation of Climate-Aware Metrics Tools for Radiology Informatics and Artificial Intelligence: Toward a Potential Radiology Ecolabel

Radiology is a major contributor to health care's impact on climate change, in part due to its reliance on energy-intensive equipment as well as its growing technological reliance. Delivering modern patient care requires a robust informatics team to move images from the imaging equipment to the workstations and the health care system. Radiology informatics is the field that manages medical imaging IT. This involves the acquisition, storage, retrieval, and use of imaging information in health care to improve access and quality, which includes PACS, cloud services, and artificial intelligence. However, the electricity consumption of computing and the life cycle of various computer components expands the carbon footprint of health care. The authors provide a general framework to understand the environmental impact of clinical radiology informatics, which includes using the international Greenhouse Gas Protocol to draft a definition of scopes of emissions pertinent to radiology informatics, as well as exploring existing tools to measure and account for these emissions. A novel standard ecolabel for radiology informatics tools, such as the Energy Star label for consumer devices or Leadership in Energy and Environmental Design certification for buildings, should be developed to promote awareness and guide radiologists and radiology informatics leaders in making environmentally conscious decisions for their clinical practice. At this critical climate juncture, the radiology community has a unique and pressing obligation to consider our shared environmental responsibility in innovating clinical technology for patient care.

Pharmacy students' perceptions on environmental sustainability in pharmacy education and practice

BackgroundGiven the negative environmental impacts of pharmaceuticals, including their contribution to healthcare's carbon footprint, pharmacists have a role in responding to the climate and biodiversity crises. Knowledge and education are required to support transitions to environmentally sustainable pharmacy practice (ESPP). The aim of this study was to explore Australian undergraduate pharmacy students' knowledge and attitudes towards environmental sustainability and ESPP curriculum content. MethodsParticipants were surveyed using an anonymous online questionnaire deployed using Qualtrics. The questionnaire comprised of two main sections: the 15-item New Ecological Paradigm (NEP) scale to determine participants' environmental attitude score, and section on students' perceptions and curricular experience of environmentally sustainable practice which was adapted from previously published surveys. The invitation with survey link was disseminated via social media, Australian pharmacy student organisations, and direct approach. Quantitative data were reported descriptively. Qualitative data from responses to open-ended questions were analysed thematically using a reflexive, recursive approach. Incomplete survey responses were excluded from the analysis. ResultsOf the 164 complete responses, 99% had previously received information on environmental sustainability. However, only 10% were knowledgeable about ESPP and only 8.5% were aware of ESPP content in their pharmacy school curriculum. Importantly, 70% of respondents saw ESPP as relevant to their future pharmacy practice, and 94% believed the pharmacy profession has a responsibility to undertake sustainability initiatives in the delivery of pharmaceutical care. ConclusionsAustralian pharmacy students lacked knowledge of ESPP and few reported having curricular exposure to ESPP content in their pharmacy degrees. Therefore, ESPP content is an important area for development in pharmacy curricula.

S723 A Quality Improvement Study to Investigate and Reduce the Overall Environmental Impact of Procedures on Our Overall Healthcare Carbon Footprint

S723 A Quality Improvement Study to Investigate and Reduce the Overall Environmental Impact of Procedures on Our Overall Healthcare Carbon Footprint

Improving environmental sustainability of intensive care units: A mini-review.

The carbon footprint of healthcare is significantly impacted by intensive care units, which has implications for climate change and planetary health. Considering this, it is crucial to implement widespread efforts to promote environmental sustainability in these units. A literature search for publications relevant to environmental sustainability of intensive care units was done using PubMed. This mini-review seeks to equip intensive care unit practitioners and managers with the knowledge necessary to measure and mitigate the carbon cost of healthcare for critically ill patients. It will also provide an overview of the current progress in this field and its future direction.

Doing our bit to save the planet: Identifying and abandoning low value surgery.

Doing our bit to save the planet: Identifying and abandoning low value surgery.

The environmental impact of surgical telemedicine: life cycle assessment of virtual vs. in-person preoperative evaluations for benign foregut disease.

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. 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. 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). 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.

How to Heal the Emerging Problems of Health Care

Summary This issue of NEJM Catalyst Innovations in Care Delivery contains articles, case studies, and research reports on electronic health record inboxes, reducing the carbon footprint of health care, a pediatric medical home located within a school, multichannel clinical contact centers, screening for health-related social needs, and transitions of care.

Gastrointestinal endoscopy's carbon footprint.

Climate change is a global emergency. Consequently, current global targets to combat the climate crisis include reaching net-zero carbon emissions by 2050 and keeping global temperature increases below 1.5 ˚C. In 2014, the healthcare carbon footprint was 5.5% of the total national footprint. Gastrointestinal endoscopy (GIE) has a large carbon footprint compared to other procedures performed in healthcare facilities. GIE was identified as the third largest generator of medical waste in healthcare facilities for the following reasons: (1) GIE is associated with high case volumes, (2) GIE patients and relatives travel frequently, (3) GIE involves the use of many nonrenewable wastes, (4) single-use devices are used during GIE, and (5) GIE is frequently reprocessed. Immediate actions to reduce the environmental impact of GIE include: (1) adhering to guidelines, (2) implementing audit strategies to determine the appropriateness of GIE, (3) avoiding unnecessary procedures, (4) using medication rationally, (4) digitalization, (5) telemedicine, (6) critical pathways, (7) outpatient procedures, (8) adequate waste management, and (9) minimizing single-use devices. In addition, sustainable infrastructure for endoscopy units, using renewable energy, and 3R (reduce, reuse, and recycle) programs are necessary to reduce the impact of GIE on the climate crisis. Consequently, healthcare providers need to work together to achieve a more sustainable future. Therefore, strategies must be implemented to achieve net-zero carbon emissions in the healthcare field, especially from GIE, by 2050.

Green nephrology: the role of telemedicine and electronic patient-reported outcomes

Chronic kidney disease (CKD) is a global public health priority. People with CKD experience high morbidity and mortality rates, often associated with multiple long-term health conditions. While the health sector tackles shortfalls across the workforce, increased treatment costs and the subsequent impacts on care delivery, the disproportionate contribution of nephrology to the overall healthcare carbon footprint, caused by high levels of resource usage and waste generation, must be confronted. Opportunities to reduce the environmental impact of kidney care might be possible through the use and evaluation of digital technological solutions; for example, telemedicine and electronic patient reported outcomes (ePROs) can ensure that each patient with CKD receives the care and treatment they require to successfully and sustainably achieve outcomes that matter to them.

The Green Surgical Block 4.0: Automation of the operating theatre's climate conditions through a real-time patient-flow solution

The energy consumed by surgery units constitutes a staggering part of the overall healthcare carbon footprint. Partly due to the demanding climate conditions necessitated by operating theatres (OTs), energy is also wasted because of poorly managed heating, ventilation and air-conditioning systems (HVACs) that consume up to 57% of the total energy used in a hospital. With their goal of optimising OTs' performance and reducing patient waiting lists, heads of surgery units worldwide do not dare to risk cancelling scheduled surgery because of problems with the OT environment conditions (ie temperature, humidity, pressure). Current solutions are monolithic, complex and completely disconnected from healthcare logic, failing to take into account the idiosyncrasy of hospitals. This article presents an innovation that uses real-time patient flow data to automate and optimise the OT's climate conditions.

Estimating the national carbon footprint of inhalers in healthcare.

Metered dose inhalers (MDIs) contain greenhouse gases which have a disproportionate effect on the carbon footprint of healthcare. There are more environmentally friendly alternatives such as dry powder inhalers (DPIs) or soft mist inhalers (SMIs). This study aims to approximate the carbon footprint of inhalers dispensed in Irish healthcare. Health Market Research data was used to examine the number of inhalers sold in Ireland in 2019 via dispensing data from pharmacy IT systems. The carbon footprint per inhaler data was then used to calculate the total carbon footprint of each drug class, and an estimate for the total carbon footprint of inhalers sold in Ireland was generated. 4,427,287 inhalers were dispensed in Ireland in 2019 of which 2,608,433 (59%) were MDIs and 1,818,854 were DPIs/SMIs (41.1%). The total carbon equivalent of these inhalers was estimated to be 54,765 tCO2. MDIs account for 59% of inhaler units dispensed but account for 97% of inhaler-related carbon emissions. Targeting inhaler prescribing offers the potential to significantly improve the carbon footprint of Irish healthcare. Establishing the current carbon footprint of the inhalers that are prescribed, dispensed, and disposed in Ireland is a necessary baseline to inform moving towards a net zero health service.

GI multisociety strategic plan on environmental sustainability.

GI multisociety strategic plan on environmental sustainability.

Environmental impact of telehealth use for pediatric surgery

BackgroundThe healthcare sector is responsible for 10% of US greenhouse gas emissions. Telehealth use may decrease healthcare's carbon footprint. Our institution introduced telehealth to support SARS-CoV-2 social distancing. We aimed to evaluate the environmental impact of telehealth rollout. MethodsWe conducted a retrospective cohort study of pediatric patients seen by a surgical or pre anesthesia provider between March 1, 2020 and March 1, 2021. We measured patient-miles saved and CO2 emissions prevented to quantify the environmental impact of telehealth. Miles saved were calculated by geodesic distance between patient home address and our institution. Emissions prevented were calculated assuming 25 miles per gallon fuel efficiency and 19.4 pounds of CO2 produced per gallon of gasoline consumed. Unadjusted Poisson regression was used to assess relationships between patient demographics, geography, and telehealth use. Results60,773 in-person and 10,626 telehealth encounters were included. This represented an 8,755% increase in telehealth use compared to the year prior. Telehealth resulted in 887,006 patient-miles saved and 688,317 fewer pounds of CO2 emitted. Demographics significantly associated with decreased telehealth use included Asian and Black/African American racial identity, Hispanic ethnic identity, and primary language other than English. Further distance from the hospital and higher area deprivation index were associated with increased telehealth use (IRR 1.0006 and 1.0077, respectively). ConclusionIncorporating telehealth into pediatric surgical and pre anesthesia clinics resulted in significant CO2 emission reductions. Expanded telehealth use could mitigate surgical and anesthesia service contributions to climate change. Racial and linguistic minority status were associated with significantly lower rates of telehealth utilization, necessitating additional inquiry into equitable telemedicine use for minoritized populations. Level of evidenceLevel IV

The carbon footprint of hospital diagnostic imaging in Australia

SummaryBackgroundPathology testing and diagnostic imaging together contribute 9% of healthcare's carbon footprint. Whilst the carbon footprint of pathology testing has been undertaken, to date, the carbon footprint of the four most common imaging modalities is unclear.MethodsWe performed a prospective life cycle assessment at two Australian university-affiliated health services of five imaging modalities: chest X-ray (CXR), mobile chest X-ray (MCXR), computerised tomography (CT), magnetic resonance imaging (MRI) and ultrasound (US). We included scanner electricity use and all consumables and associated waste, including bedding, imaging contrast, and gloves. Analysis was performed using both attributional and consequential life cycle assessment methods. The primary outcome was the greenhouse gas footprint, measured in carbon dioxide equivalent (CO2e) emissions.FindingsMean CO2e emissions were 17·5 kg/scan for MRI; 9·2 kg/scan for CT; 0·8 kg/scan for CXR; 0·5 kg/scan for MCXR; and 0·5 kg/scan for US. Emissions from scanners from standby energy were substantial. When expressed as emissions per additional scan (results of consequential analysis) impacts were lower: 1·1 kg/scan for MRI; 1·1 kg/scan for CT; 0·6 kg/scan for CXR; 0·1 kg/scan for MCXR; and 0·1 kg/scan for US, due to emissions from standby power being excluded.InterpretationClinicians and administrators can reduce carbon emissions from diagnostic imaging, firstly by reducing the ordering of unnecessary imaging, or by ordering low-impact imaging (X-ray and US) in place of high-impact MRI and CT when clinically appropriate to do so. Secondly, whenever possible, scanners should be turned off to reduce emissions from standby power. Thirdly, ensuring high utilisation rates for scanners both reduces the time they spend in standby, and apportions the impacts of the reduced standby power of a greater number of scans. This therefore reduces the impact on any individual scan, maximising resource efficiency.FundingHealthy Urban Environments (HUE) Collaboratory of the Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise MBG SPHERE. The National Health and Medical Research Council (NHMRC) PhD scholarship

High value health care is low carbon health care.

We are in a health emergency precipitated by climate change.1 As well as physical health threats, climate change and its effects are adversely affecting Australians' mental health,2 and worsening the health inequities suffered by vulnerable populations. In response, the Australian health care community must both adapt to increased demand and to deteriorating environmental conditions, and mitigate the carbon footprint of health care, currently 7% of our national carbon emissions.3 Using economic data from 360 sectors, Malik and colleagues3 estimated carbon emissions by Australian Institute of Health and Welfare categories of health care expenditure, finding that the hospital and pharmaceutical sectors had the largest footprints, together accounting for 63% of health care emissions.

What is the healthcare carbon footprint? A collaborative analysis of current literature

Abstract Background Climate change (CC) is a public health (PH) issue of growing concern. Health care systems in every country have a significant impact in terms of greenhouse gas emissions (GHGE) causing global warming, but there seems to be a general lack of knowledge about this. As members of the junior study group on CC and PH of the Italian Society of Hygiene (SItI), we launched a project of shared education and literature research about the carbon footprint of healthcare (HCCF). We believe such an effort to be useful in spreading awareness and promoting change both in clinical practice, health care management and at policymaking level. Objectives To answer these questions: What is the estimated national and global HCCF? Which activities contribute to HCCF? What are the possible actions and policies to reduce HCCF while providing universal health care of good quality in all countries? From Dec 2019 to Feb 2020 we used databases and backward citation searching to retrieve references which we split among individuals to process, then we shared summaries of the material with the group. Results HCCF makes about 4.4% of all GHGE, with important variations among countries. We found estimates on emissions for various activities (e.g. operating theatres) and items (e.g. inhalers), as well as proposed solutions for practitioners, managers, manufacturers and policymakers (e.g. low-impact technologies, advocacy, health promotion to reduce healthcare volumes). Conclusions HCCF is complex, attributable to many components and amenable to mitigation through actions at all levels, with additional benefits for efficiency and public health. These conclusions are relevant for all countries as they imply joint international and transversal efforts throughout the world's health care sector. Key messages Current data and analysis, available for several services and in many countries, show healthcare carbon footprint is significant. Emissions from health sector can be reduced while granting universal healthcare globally.

Carbon emission trends and sustainability options in Austrian health care

Health care is one of the largest and fastest growing service sectors in OECD countries and a significant contributor to climate change. Health care is also indispensable for human well-being. It is therefore crucial to understand how the health care sector can reduce its emissions without undermining its service quality. We break down the carbon emissions of Austrian health care in unprecedented detail over a decade starting in 2005. We calculated the carbon footprints of Austrian health care providers and further decomposed the emissions attributable to hospitals, the largest health care provider in Austria. We estimated detailed life cycle assessments of the carbon emissions attributable to energy use, the use of selected pharmaceuticals and medical goods and induced private travel.The Austrian health carbon footprint amounted to 6.8 million tons of CO2 in 2014, a decline of 14% since 2005, mainly due to the rising shares of renewables in the Austrian energy sector. Complementary calculations of the carbon emissions from energy use by Austrian health care providers confirm this finding. Goods purchased by hospitals, pharmaceuticals and other medical non-durables stand out as especially large contributors to the health carbon footprint. Carbon emissions attributable to induced travel increased by 15%, indicating the need to better align planning of health care provision with transport and spatial planning. Concluding, we argue that many untapped possibilities for reducing the carbon footprint of health care exist and propose six concrete steps towards sustainable health care that are applicable to most industrial countries.

Healthcare in a carbon-constrained world.

Objective The climate crisis necessitates urgent decarbonisation. The health sector must address its large carbon footprint. In the present study, we sought healthcare thought leaders' views about a future environmentally sustainable health system. Methods The present study was a qualitative exploratory study consisting of semistructured, in-depth interviews with 15 healthcare thought leaders from Australia, the UK, the US and New Zealand. Audio recordings of the interviews were transcribed and analysed by matrix display and thematic analysis. Results Overall, healthcare thought leaders believe that to reduce the carbon footprint of healthcare we need to look beyond traditional 'green' initiatives towards a more fundamental and longer-term redesign. Five main themes and one 'key enabler' (information communication technology) were identified. In this paper we draw on other relevant findings, but chiefly focus on the fifth theme about reshaping the role of healthcare within society and using the size and influence of the health sector to leverage wider health, environmental and societal benefits. Conclusions These ideas represent potentially low-carbon models of care. The next step would be to pilot and measure the outcomes (health, environmental, financial) of these models. What is known about the topic? The health sector needs to reduce its large carbon footprint. Traditional 'green' initiatives, such as recycling and improving energy efficiency, are insufficient to achieve the scale of decarbonisation required. What does this paper add? Healthcare thought leaders surveyed in the present study suggested that we also consider other, non-traditional ways to achieve environmental sustainability. In this paper we discuss their ideas about adopting an anticipatory approach to healthcare using predictive analytics, and using the size and influence of the health sector to effect wider health and environmental benefits. What are the implications for practitioners? Achieving an environmentally sustainable healthcare system is likely to require broad and fundamental (i.e. transformational) change to the current service model. Health practitioners throughout the sector must be closely engaged in this process.