Written by The climate emergency is not just an environmental issue, it’s the single greatest public health challenge of the 21st century, projected to cause hundreds of thousands of additional deaths globally each year.
The healthcare sector itself is a significant contributor to this crisis, accounting for approximately 10% of total greenhouse gas (GHG) emissions in the United States. Healthcare organizations are caught in the middle. They will be tasked to lead the response to climate change as health impacts increase due to changes in climate, and they will be asked to reduce their own environmental footprint.
To address this challenge effectively, the IHI, in collaboration with health systems and experts, has identified a unified theory of change and a set of evidence-based interventions.
Three key clinical domains have been prioritized:
- Anesthetic gases – Inhaled anesthetic agents like desflurane and nitrous oxide are potent GHGs, with around 95% of the gas used per case being vented into the atmosphere.
- Strategies for anesthetic gases include minimizing fresh flow rates, managing anesthetic choices (e.g., replacing desflurane with sevoflurane or isoflurane), and decommissioning central nitrous piping. Engaging clinicians through awareness-raising and real-time data feedback is also crucial. For example, Seattle Children’s Hospital reduced GHG emissions from anesthesia by 87% through education campaigns and new protocols, while Stanford Health Care successfully piloted replacing centrally piped nitrous oxide with portable E-cylinders to eliminate leakage.
- Inhalers – Metered-dose inhalers (MDIs) contain hydrofluorocarbons (HFCs), another powerful GHG, and their annual emissions in the US are comparable to 500,000 automobiles.
- Key strategies involve preventing disease exacerbation through better preventive care, launching appropriate use campaigns, and empowering clinicians to shift from MDIs to lower-carbon alternatives like dry powder inhalers (DPIs). Mass General Brigham is developing EHR tools and educational materials to support this transition.
- Medical products – Medical devices and supplies contribute about 7% of US healthcare sector GHG emissions, particularly single-use items that end up in the landfill.
- Priorities include promoting appropriate care to target systemic medical overuse (e.g., reducing unnecessary tests and limiting prescription durations), reducing overuse of medical supplies (e.g., transitioning to reusable linens and surgical gowns), and optimizing resource utilization (e.g., reforming OR kits and maximizing device reprocessing). Additionally, improving medication management and adopting environmentally sustainable purchasing practices are vital. Northwest Permanente, for instance, implemented a “Wait, Don’t Waste” initiative in their ORs by only opening items that are actually used, eliminating an estimated 15 metric tons of CO2 emissions in the first year. Throughout these efforts, collaboration with infection prevention control is essential to ensure safety and quality standards are maintained.
The aim of these clinical decarbonization efforts is to reduce greenhouse gas emissions in clinical settings while simultaneously reducing costs and maintaining, or even improving, patient safety and quality.
Measurement is key, with primary outcomes focusing on total GHG emissions in carbon dioxide equivalents (CO2e). Process measures like anesthesia emissions intensity, the percentage of MDI prescriptions, and the volume of unused supplies provide vital insights into progress.
By understanding their impact and implementing strategic changes, healthcare organizations are not only improving care delivery but also becoming powerful agents in the fight against climate change.
The Institute for Healthcare Improvement (IHI) highlights this urgent need, working to accelerate decarbonization efforts within clinical care delivery. You can download the entire report from https://www.ihi.org/resources/tools/accelerating-decarbonization-clinical-care