Faculty Bibliography

Evidence-based design (EBD) studies have grown rapidly over the last decade, attempting to link traditional building design to building occupants, with a particular emphasis on healthcare settings. Additionally, there has been an increase in green building design (GBD) for most new construction; however, the effects of GBD on the use phase and occupant health is not well studied. This study captured the impact of both EBD and green building strategies by analyzing different metrics across a 3-year period for the same unit (oncology) spanning the traditional hospital (Unit 2800) space and the new green addition (Unit 5800). Of the six categories analyzed, quality of care, productivity, and utilities all stayed relatively unchanged from Unit 2800 to Unit 5800, with a slight decrease in number of staff needed due to a lower census. Expenses, staff satisfaction, and patient satisfaction saw a general upward trend from Unit 2800 to Unit 5800. As the green building industry continues to grow, quantitative analysis on occupant satisfaction and EBD, such as this study, can inform designers and healthcare providers on the impact of their green design decisions.

PURPOSE OF REVIEW: This article raises awareness about the cost-effectiveness and carbon footprint of various cataract surgery techniques, comparing their relative carbon emissions and expenses: manual small-incision cataract surgery (MSICS), phacoemulsification, and femtosecond laser-assisted cataract surgery. RECENT FINDINGS: As the most commonly performed surgical procedure worldwide, cataract surgery contributes significantly to global climate change. The carbon footprint of a single phacoemulsification cataract surgery is estimated to be comparable to that of a typical person's life for 1 week. Phacoemulsification has been estimated to be between 1.4 and 4.7 times more expensive than MSICS; however, given the lower degree of postoperative astigmatism and other potential complications, phacoemulsification may still be preferable to MSICS in relatively resource-rich settings requiring high levels of visual function. Limited data are currently available regarding the environmental and financial impact of femtosecond laser-assisted cataract surgery; however, in its current form, it appears to be the least cost-effective option. SUMMARY: Cataract surgery has a high value to patients. The relative environmental impact and cost of different types of cataract surgery should be considered as this treatment becomes even more broadly available globally and as new technologies are developed and implemented.

The healthcare sector is a driver of economic growth in the U.S., with spending on healthcare in 2012 reaching $2.8 trillion, or 17% of the U.S. gross domestic product, but it is also a significant source of emissions that adversely impact environmental and public health. The current state of the healthcare industry offers significant opportunities for environmental efficiency improvements, potentially leading to reductions in costs, resource use, and waste without compromising patient care. However, limited research exists that can provide quantitative, sustainable solutions. The operating room is the most resource-intensive area of a hospital, and surgery is therefore an important focal point to understand healthcare-related emissions. Hybrid life cycle assessment (LCA) was used to quantify environmental emissions from four different surgical approaches (abdominal, vaginal, laparoscopic, and robotic) used in the second most common major procedure for women in the U.S., the hysterectomy. Data were collected from 62 cases of hysterectomy. Life cycle assessment results show that major sources of environmental emissions include the production of disposable materials and single-use surgical devices, energy used for heating, ventilation, and air conditioning, and anesthetic gases. By scientifically evaluating emissions, the healthcare industry can strategically optimize its transition to a more sustainable system.

Disposable materials contribute to healthcare's estimated production of 33 pounds of waste per patient bed per day or approximately 5.9 million tons of waste each year. The shift toward disposable materials was initially driven by a variety of factors including the potential for infection control, convenience, and cost. The current use of single-use disposables in healthcare, however, has become costly, wasteful, and to some extent, unnecessary. Disposable custom packs, a set of products prepackaged for a specific procedure to reduce time and error, are utilized in nearly every medical procedure performed in the US and internationally. This study analyzed 15 custom packs from geographically diverse hospitals using life cycle assessment and design for the environment. Polypropylene, the material used to make gowns and drapes, was the most prominent material by weight, followed by cotton. However, the life cycle assessment results show that cotton composed the largest portion of environmental impacts in every,category. Finally, a new green custom pack was designed. By using tools and strategies such as life cycle assessment and design for the environment,, healthcare institutions can make educated streamlining efforts for their disposable custom packs. (C) 2015 Elsevier Ltd. All rights reserved.

The aim of this study was to conduct a whole-building analysis using a host of metrics, including green building metrics, with the goal of providing designers and healthcare providers quantitative data that can be used in their design and operations decisions. The intent was to fill a gap in the research, which previously analyzed only individual rooms, specific design elements, and green building metrics. Therefore, a comparative longitudinal assessment was completed that quantified the effects of building design on performance of a pediatric healthcare facility by comparing a new, LEED-certified hospital relative to its previous, traditional counterpart. This study found statistically significant improvements in productivity, staff satisfaction, and quality of care, including a 19% decrease in actual mortalities despite an 11% increase in expected mortalities (both P = 0.005). Children's energy consumption and electricity per square meter decreased over 50%, while water and sewage intensity decreased over 60% (all P < 0.001). In their LEED-certified facility, Children's significantly improved their productivity, quality of care, and staff satisfaction, in addition to utility intensity. These improvements can be credited to green building design, mechanical equipment upgrades, and organizational or cultural shifts related to Magnet nursing designation. (C) 2014 Elsevier Ltd. All rights reserved.

This study analyzed the environmental impacts of the materials phase of a net-zero energy building. The Center for Sustainable Landscapes (CSL) is a three-story, 24,350 square foot educational, research, and administrative office in Pittsburgh, PA, USA. This net-zero energy building is designed to meet Living Building Challenge criteria. The largest environmental impacts from the production of building materials is from concrete, structural steel, photovoltaic (PV) panels, inverters, and gravel. Comparing the LCA results of the CSL to standard commercial structures reveals a 10% larger global warming potential and a nearly equal embodied energy per square feet, largely due to the CSL's PV system. As a net-zero energy building, the environmental impacts associated with the use phase are expected to be very low relative to standard structures. Future studies will incorporate the construction and use phases of the CSL for a more comprehensive life cycle perspective.

This study introduces life cycle assessment as a tool to analyze one aspect of sustainability in healthcare: the birth of a baby. The process life cycle assessment case study presented evaluates two common procedures in a hospital, a cesarean section and a vaginal birth. This case study was conducted at Magee-Womens Hospital of the University of Pittsburgh Medical Center, which delivers over 10,000 infants per year. The results show that heating, ventilation, and air conditioning (HVAC), waste disposal, and the production of the disposable custom packs comprise a large percentage of the environmental impacts. Applying the life cycle assessment tool to medical procedures allows hospital decision makers to target and guide efforts to reduce the environmental impacts of healthcare procedures.

A fundamental principle of business states that the primary purpose of a corporation is to generate a profit for its stakeholders. Historical belief posited that this profit must come at the expense of the environment and that environmental health and corporate profitability are mutually exclusive principles. More recently however, the ideas of corporate citizenship and sustainable development have demonstrated that corporations have a larger role than simply generating a profit. Some corporations have begun to evolve by including the principles of sustainable development and the triple bottom line into their growth and development plans. Promoting social well-being, minimizing environmental degradation, as well as maximizing economic profitability, is quickly becoming common practice. © 2012 IEEE.