Faculty Bibliography

Healthcare generates large amounts of waste, harming both environmental and human health. Waste audits are the standard method for measuring and characterizing waste. This is a systematic review of healthcare waste audits, describing their methods and informing more standardized auditing and reporting. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE, Embase, Inspec, Scopus and Web of Science Core Collection databases for published studies involving direct measurement of waste in medical facilities. We screened 2398 studies, identifying 156 studies for inclusion from 37 countries. Most were conducted to improve local waste sorting policies or practices, with fewer to inform policy development, increase waste diversion or reduce costs. Measurement was quantified mostly by weighing waste, with many also counting items or using interviews or surveys to compile data. Studies spanned single procedures, departments and hospitals, and multiple hospitals or health systems. Waste categories varied, with most including municipal solid waste or biohazardous waste, and others including sharps, recycling and other wastes. There were significant differences in methods and results between high- and low-income countries. The number of healthcare waste audits published has been increasing, with variable quality and general methodologic inconsistency. A greater emphasis on consistent performance and reporting standards would improve the quality, comparability and usefulness of healthcare waste audits.

The demand for eye care-the most common medical speciality in some countries-is increasing globally due to both demographic change and the development of eye health-care services in low-income and middle-income countries. This expansion of service provision needs to be environmentally sustainable. We conducted a scoping review to establish the nature and extent of the literature describing the environmental costs of delivering eye-care services, identify interventions to diminish the environmental impact of eye care, and identify key sustainability themes that are not yet being addressed. We identified 16 peer-reviewed articles for analysis, all published since 2009. Despite a paucity of research evidence, there is a need for the measurement of environmental impacts associated with eye care to be standardised along with the methodological tools to assess these impacts. The vastly different environmental costs of delivering clinical services with similar clinical outcomes in different regulatory settings is striking; in one example, a phacoemulsification cataract extraction in a UK hospital produced more than 20 times the greenhouse gas emission of the same procedure in an Indian hospital. The environmental costs must be systematically included when evaluating the risks and benefits of new interventions or policies aimed at promoting safety in high-income countries.

There is increasing understanding, globally, that climate change and increased pollution will have a profound and mostly harmful effect on human health. This review brings together international experts to describe both the direct (such as heat waves) and indirect (such as vector-borne disease incidence) health impacts of climate change. These impacts vary depending on vulnerability (i.e., existing diseases) and the international, economic, political, and environmental context. This unique review also expands on these issues to address a third category of potential longer-term impacts on global health: famine, population dislocation, and environmental justice and education. This scholarly resource explores these issues fully, linking them to global health in urban and rural settings in developed and developing countries. The review finishes with a practical discussion of action that health professionals around the world in our field can yet take.

BACKGROUND/UNASSIGNED:The US health care system is the second largest contributor of trash. Approximately 20% to 70% of waste is produced by operating rooms, and very few of this waste is recycled. The purpose of this study is to quantify the opened but unused disposable supplies and generate strategies to reduce disposable waste. METHODS/UNASSIGNED:-e), a measure of greenhouse gas emissions. RESULTS/UNASSIGNED:-e during the study period. CONCLUSIONS/UNASSIGNED:This study highlights the excessive waste of unused disposable products during hand surgery cases and identifies ways of improvement.

OBJECTIVES/OBJECTIVE:High-value care is providing high quality care at low cost; we sought to define hospital value and identify the characteristics of hospitals which provide high-value care. DESIGN/METHODS:Retrospective observational study. SETTING/METHODS:Acute care hospitals in the USA. PARTICIPANTS/METHODS:All Medicare beneficiaries with claims included in Center for Medicare & Medicaid Services Overall Star Ratings or in publicly available Medicare spending per beneficiary data. PRIMARY AND SECONDARY OUTCOME MEASURES/METHODS:Our primary outcome was value defined as the difference between Star Ratings quality score and Medicare spending; the secondary outcome was classification as a 4 or 5 star hospital with lowest quintile Medicare spending ('high value') or 1 or 2 star hospital with highest quintile spending ('low value'). RESULTS:Two thousand nine hundred and fourteen hospitals had both quality and spending data, and were included. The value score had a mean (SD) of 0.58 (1.79). A total of 286 hospitals were classified as high value; these represented 28.6% of 999 4 and 5 star hospitals and 46.8% of 611 low cost hospitals. A total of 258 hospitals were classified as low value; these represented 26.6% of 970 1 and 2 star hospitals and 49.3% of 523 high cost hospitals. In regression models ownership, non-teaching status, beds, urbanity, nurse to bed ratio, percentage of dual eligible Medicare patients and percentage of disproportionate share hospital payments were associated with the primary value score. CONCLUSIONS:There are high quality hospitals that are not high value, and a number of factors are strongly associated with being low or high value. These findings can inform efforts of policymakers and hospitals to increase the value of care.

OBJECTIVES/OBJECTIVE:Given adverse health effects of climate change and contributions of the US health care sector to greenhouse gas (GHG) emissions, environmentally sustainable delivery of care is needed. We applied life cycle assessment to quantify GHGs associated with processing a gastrointestinal biopsy in order to identify emissions hotspots and guide mitigation strategies. METHODS:The biopsy process at a large academic pathology laboratory was grouped into steps. Each supply and reagent was catalogued and postuse treatment noted. Energy consumption was estimated for capital equipment. Two common scenarios were considered: 1 case with 1 specimen jar (scenario 1) and 1 case with 3 specimen jars (scenario 2). RESULTS:Scenario 1 generated 0.29 kg of carbon dioxide equivalents (kg CO2e), whereas scenario 2 resulted in 0.79 kg CO2e-equivalent to 0.7 and 2.0 miles driven, respectively. The largest proportion of GHGs (36%) in either scenario came from the tissue processor step. The second largest contributor (19%) was case accessioning, mostly attributable to production of single-use disposable jars. CONCLUSIONS:Applied to more than 20 million biopsies performed in the US annually, emissions from biopsy processing is equivalent to yearly GHG emissions from 1,200 passenger cars. Mitigation strategies may include modification of surveillance guidelines to include the number of specimen jars.

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.

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.