Faculty Bibliography

The healthcare sector is responsible for 8.5% of greenhouse gas (GHG) emissions in the United States. To prevent catastrophic effects of climate change, urgent reductions in GHG emissions are needed. Unnecessary preoperative testing and clinic visits contribute to excessive utilization of healthcare resources and patient travel, and addressing them may help reduce emissions. A retrospective cross-sectional analysis of GHG emissions associated with pre- and post- implementation of a novel telehealth preoperative evaluation process was performed on 298 American Society of Anesthesiologists Class I-III patients undergoing elective spine surgery at Yale New Haven Hospital. Electronic health records were evaluated to determine patient health status and necessary or unnecessary preoperative tests and clinic visits. Life cycle assessment and U.S. EPA GHG calculator were used to estimate carbon dioxide equivalent (CO2e) emissions from preoperative testing, clinic visits, and patient commuting. GHG emissions were reduced by 8.09 kg CO2e (9.6%) per patient, from 84.52 kg CO2e pre-intervention to 76.43 kg CO2e post-intervention (p = 0.019). The largest reduction, 14.71 kg CO2e, stemmed from fewer in-person clinic evaluations. An additional reduction of 18.07 kg CO2e per patient would have been possible if clinic performance were optimized (only necessary testing performed), resulting in a total reduction of 26.16 kg CO2e (31%). A preoperative clinic using established testing guidelines and telehealth can reduce environmental emissions. With more than 40 million annual surgeries nationwide, concerted effort to reduce unnecessary testing and visits should help curtail healthcare GHG emissions.

PURPOSE/OBJECTIVE:To calculate the volume of greenhouse gases (GHG) generated by a hospital-based interventional radiology department. MATERIALS AND METHODS/METHODS:Life cycle assessment (LCA) was used to calculate GHG emitted by an IR department at a tertiary care academic medical center during a single workweek. The volume of waste generated, the amount of disposable supplies and linens used, and the operating time of electrical equipment were recorded for each procedure performed between 7:00AM-7:00PM on five consecutive weekdays. LCA was then performed using purchasing data, plug loads for electrical hardware, data from temperature control units, and estimates of emissions related to travel in the area surrounding the medical center. RESULTS:e). CONCLUSION/CONCLUSIONS:The practice of interventional radiology generates substantial volumes of greenhouse gases, a majority of which come from energy used to power climate control followed by emissions related to the production and transportation of single use supplies. Efforts to reduce energy consumption and the use of disposable supplies may decrease GHG emissions and IR's contribution to climate change.

Objective/UNASSIGNED:Though one of the most common surgeries, there is limited information on variability of practices in cataract surgeries. 'Eyefficiency' is a cataract surgical services auditing tool to help global units improve their surgical productivity and reduce their costs, waste generation and carbon footprint. The aim of the present research is to identify variability and efficiency opportunities in cataract surgical practices globally. Methods and Analysis/UNASSIGNED:9 global cataract surgical facilities used the Eyefficiency tool to collect facility-level data (staffing, pathway steps, costs of supplies and energy use), and live time-and-motion data. A point person from each site gathered and reported data on 1 week or 30 consecutive cataract surgeries. Environmental life cycle assessment and descriptive statistics were used to quantify productivity, costs and carbon footprint. The main outcomes were estimates of productivity, costs, greenhouse gas emissions, and solid waste generation per-case at each site. Results/UNASSIGNED:Nine participating sites recorded 475 cataract extractions (a mix of phacoemulsification and manual small incision). Cases per hour ranged from 1.7 to 4.48 at single-bed sites and 1.47 to 4.25 at dual-bed sites. Average per-case expenditures ranged between £31.55 and £399.34, with a majority of costs attributable to medical equipment and supplies. Average solid waste ranged between 0.19 kg and 4.27 kg per phacoemulsification, and greenhouse gases ranged from 41 kg carbon dioxide equivalents (CO2e) to 130 kg CO2e per phacoemulsification. Conclusion/UNASSIGNED:Results demonstrate the global diversity of cataract surgical services and non-clinical metrics. Eyefficiency supports local decision-making for resource efficiency and could help identify regional or global best practices for optimising productivity, costs and environmental impact of cataract surgery.

This study measured the total quantity and composition of waste generated in a large, New York City (NYC) hospital kitchen over a one-day period to assess the impact of potential waste diversion strategies in potential weight of waste diverted from landfill and reduction in greenhouse gas (GHG) emissions. During the one-day audit, the hospital kitchen generated 1515.15 kg (1.7 US tons) of solid waste daily or 0.23 kg of total waste per meal served. Extrapolating to all meals served in 2019, the hospital kitchen generates over 442,067 kg (487 US tons) of waste and emits approximately 294,466 kg of CO2e annually from waste disposal. Most of this waste (85%, 376,247 kg or 415 US tons annually) is currently sent to landfill. With feasible changes, including increased recycling and moderate composting, this hospital could reduce landfilled waste by 205,245 kg (226 US tons, or 55% reduction) and reduce GHG emissions by 189,025 kg CO2e (64% reduction). Given NYC's ambitious waste and GHG emission reduction targets outlined in its OneNYC strategic plan, studies analyzing composition, emissions, and waste diversion potential of large institutions can be valuable in achieving city sustainability goals.

A circular economy involves maintaining manufactured products in circulation, distributing resource and environmental costs over time and with repeated use. In a linear supply chain, manufactured products are used once and discarded. In high-income nations, health care systems increasingly rely on linear supply chains composed of single-use disposable medical devices. This has resulted in increased health care expenditures and health care-generated waste and pollution, with associated public health damage. It has also caused the supply chain to be vulnerable to disruption and demand fluctuations. Transformation of the medical device industry to a more circular economy would advance the goal of providing increasingly complex care in a low-emissions future. Barriers to circularity include perceptions regarding infection prevention, behaviors of device consumers and manufacturers, and regulatory structures that encourage the proliferation of disposable medical devices. Complementary policy- and market-driven solutions are needed to encourage systemic transformation.

Healthcare is a major emitter of environmental pollutants that adversely affect health. Within the healthcare community, awareness of these effects is low, and recognition of the duty to address them is only beginning to gain traction. Healthcare sustainability science explores dimensions of resource consumption and environmental emissions associated with healthcare activities. This emerging field provides tools and metrics to quantify the unintended consequences of healthcare delivery and evaluate effective approaches that improve patient safety while protecting public health. This narrative review describes the scope of healthcare sustainability research, identifies knowledge gaps, introduces a framework for applications of existing research methods and tools to the healthcare context, and establishes research priorities to improve the environmental performance of healthcare services. The framework was developed through review of the current state of healthcare sustainability science and expert consensus by the Working Group for Environmental Sustainability in Clinical Care. Key recommendations include: development of a comprehensive life cycle inventory database for medical devices and drugs; application of standardized sustainability performance metrics for clinician, hospital/health system, and national levels; revision of infection control standards driving non-evidence-based uptake of single-use disposable devices; call for increased federal research funding; and formation of a Global Commission on the Advancement of Environmental Sustainability in Healthcare. There is urgent need for research that informs policy and practice to address the public health crisis arising from healthcare pollution. A transformational vision is required to align research priorities to achieve a sustainable healthcare system that advances quality, safety and value.

INTRODUCTION/BACKGROUND:Healthcare contributes 10% of greenhouse gases in the United States and generates two milion tons of waste each year. Reducing healthcare waste can reduce the environmental impact of healthcare and lower hospitals' waste disposal costs. However, no literature to date has examined US emergency department (ED) waste management. The purpose of this study was to quantify and describe the amount of waste generated by an ED, identify deviations from waste policy, and explore areas for waste reduction. METHODS:We conducted a 24-hour (weekday) ED waste audit in an urban, tertiary-care academic medical center. All waste generated in the ED during the study period was collected, manually sorted into separate categories based on its predominant material, and weighed. We tracked deviations from hospital waste policy using the hospital's Infection Control Manual, state regulations, and Health Insurance Portability and Accountability Act standards. Lastly, we calculated direct pollutant emissions from ED waste disposal activities using the M+WasteCare Calculator. RESULTS:The ED generated 671.8 kilograms (kg) total waste during a 24-hour collection period. On a per-patient basis, the ED generated 1.99 kg of total waste per encounter. The majority was plastic (64.6%), with paper-derived products (18.4%) the next largest category. Only 14.9% of waste disposed of in red bags met the criteria for regulated medical waste. We identified several deviations from waste policy, including loose sharps not placed in sharps containers, as well as re-processable items and protected health information thrown in medical and solid waste. We also identified over 200 unused items. Pollutant emissions resulting per day from ED waste disposal include 3110 kg carbon dioxide equivalent and 576 grams of other criteria pollutants, heavy metals, and toxins. CONCLUSION/CONCLUSIONS:The ED generates significant amounts of waste. Current ED waste disposal practices reveal several opportunities to reduce total waste generated, increase adherence to waste policy, and reduce environmental impact. While our results will likely be similar to other urban tertiary EDs that serve as Level I trauma centers, future studies are needed to compare results across EDs with different patient volumes or waste generation rates.

Cataract surgery is the most commonly performed medical procedure in the world but there continues to be a large, unmet requirement for more surgery, with cataract still accounting for one third of all global blindness. A great deal of progress has been made in increasing cataract surgical rates or productivity, and associated cost containment. However, there is currently no audit tool which facilitates capture of routine cataract surgical productivity, solid waste, carbon, and cost-related data which could be used for global benchmarking, learning, and improvement. The Eyefficiency tool, discussed here, develops a universal Life Cycle Assessment (LCA) methodology for cataract surgery to identify opportunities for sites to minimize the footprint of cataract surgical services and increase access to cataract surgery for patients worldwide. Here, we describe the LCA approaches tested for use in Eyefficiency, with the goals of creating an easy-to-use, open source tool that is also easy to maintain and update. Given those goals, the development team chose to use a hybrid LCA approach with UK-based process and environmental extended input"“output inventories. The carbon results of the Eyefficiency tool are compared to previous studies at two of Eyefficiency's pilot test sites. Though Eyefficiency's carbon calculator may only provide order of magnitude accuracy, it offers cataract surgical providers everywhere in the world an opportunity to benchmark their costs, throughput, waste generation, and carbon emissions. Eyefficiency enables ground level ownership in sustainable pathways for the most common medical procedure worldwide.

Waste auditing is important for effectively reducing the medical waste generated by resource-intensive operating rooms. To replace the current time-intensive and dangerous manual waste auditing method, we propose a system named iWASTE to detect and classify medical waste based on videos recorded by a camera-equipped waste container. In this pilot study, we collected a video dataset of 4 waste items (gloves, hairnet, mask, and shoecover) and designed a motion detection based preprocessing method to extract and trim useful frames. We propose a novel architecture named R3D+C2D to classify waste videos by combining features learnt by 2D convolutional and 3D convolutional neural networks. The proposed method obtained a promising result (79.99% accuracy) on our challenging dataset.Clinical Relevance-iWaste enables consistent and effective real-time monitoring of solid waste generation in operating rooms, which can be used to enforce medical waste sorting policies and to identify waste reduction strategies.