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Less Gas More Green
Share PrintTo decrease a facility’s CO2 footprint, anesthesia providers can lower their fresh gas flow during an anesthetic that is completely safe for patients. This lowering results in a decrease in anesthetic pollution of the environment and a decrease in expenditure on anesthesia gases. This solution can be easily taught, but healthcare providers are sometimes resistant to change, especially when the behavior change seems complicated. Through an educational approach, providers will be asked explicitly to stop using desflurane, nitrous oxide, and to decrease their fresh gas flows to under 2 liters.
Origin:
April 2022, Richmond VA Medical Center (Richmond, Virginia)
Adoptions:
4 successful, 2 in-progress
Awards and Recognition:
iNET Seed Investee, iNET Spread Investee, Quality on Parade People's Choice Winner 2023, VA Strong Practice Forum: February 2024, VA Lean Yellow Belt awardee: January 2024, Challen ... iNET Seed Investee, iNET Spread Investee, Quality on Parade People's Choice Winner 2023, VA Strong Practice Forum: February 2024, VA Lean Yellow Belt awardee: January 2024, Challenge Innovation Competition: collaboration between Office of Climate Change and Health Equity and the VHA Innovation Ecosytem, Featured Innovation on Diffusion Marketplace Newsletter: February 2024
Partners:
Anesthesiology
Recent Updates
Overview
Problem
When an anesthetic is performed, all the excess gas is that isn't used is pushed into the atmosphere via a waste system where it contributes to GHG formation. One of the agents used equates t ... Healthcare is a giant amongst greenhouse house gas (GHG) contributors. Hospitals produce enormous amounts of waste, and operating rooms account for 30% of this waste.
When an anesthetic is performed, all the excess gas is that isn't used is pushed into the atmosphere via a waste system where it contributes to GHG formation. One of the agents used equates to driving 420 mph in CO2 production and this very same gas was recently banned in Scotland. Additionally, another one of the agents used lasts in the atmosphere for 114 years.
Over the course of the investment cycle, a prototype educational series was delivered to various anesthesia provider groups, feedback was sought from these groups, and the iterative process completed. Through this process of iteration, a program was developed that met most the users needs without complicating the material excessively.
Prototyping allowed me to pivot quickly and refine the program to really help to distill the message. Healthcare providers are typically inundated with new information, research, and procedures. It was super important to me to make sure my messaging accounted for this, thus achieving a true human-centered design approach. See more
Images
Videos
- Articles referring to impact of anesthesia gases to climate and practice of low flow anesthesia References
- Center by center usage of all anesthestic agents from procurement data: Appendix D A Select Review of VHA’s Implementation of the VA Sustainability Plan
- EPA CALC EPA calculator
Files
Links
Solution
Videos
- Printable methodology Low flow with Isoflurane
- Printable methodology Low flow with Sevoflurane
- Memo from Assistant Under Secretary for Health for Clinical Services Memo on Reductions in Anesthesia Carbon Footprint
- A list of pertinent research articles and informational white papers Comprehensive references
- Gas Man® is the answer for teaching, experimenting and planning anesthesia administration on the computer before trying it in the operating room. Gas Man® is used by hundreds of practicing anesthesia providers and dozens of medical and veterinary teaching programs around the world. Computer Teaching Tool for Uptake and Distribution
- An official podcast of the American Society of Anesthesiologists, this episode of Central Line offers an in-depth exploration on Low Flow Anesthesia. Dr. Adam Striker discusses low-flow anesthesia with Drs. Jeffrey M. Feldman and David Hovord. Podcast on low flow anesthesia
Files
Links
Results
In addition to the cost avoidance, Richmond VAMC reduced it's CO2 footprint, removing an estimated 13 gas-powered vehicles from the road for a full year.
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
-
1-2 months
Process Buildout-Identify champions/early adopters-Train personnel to administer low flow anesthesia-Engage with local leadership and stakeholders to gain buy-in-Provide ongoing support -
3-6 months
Program evaluation and measurement outcomes:-measure impact on system performance from pharmacy purchasing data pre- and post-implementation-measure the extent of spread via staff surveys pre- and post-implementation
Departments
- Anesthesia
- Bariatric surgery
- Pharmacy
- Cardiovascular surgery
- Colon and rectal surgery
- Dental/oral surgery
- Neurosurgery
- Outpatient surgery
Core Resources
Resource type | Resource description |
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PEOPLE |
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PROCESSES |
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TOOLS |
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Files
- Comprehensive review of low flow techniques Theory of low flow
- Concentration of NaOH in modern CO2 absorbers CO2 Absorption
- Observational cohort of heat-related illness Heat-Related Illness
- Primer on health sector decarbonization AHRQ
Links
- Draeger white paper on Clinical Techniques of Low-flow and Minimal-flow anesthesia
- 2023 Committee on Equipment and Facilities Statement on the use of low-flow anesthesia for Sevoflurane ASA statement of proven safety of low-flow
- This course consists of 8 topics designed to empower the anesthesia professional with the knowledge required to safely and effectively reduce anesthetic waste and pollution through the practice of low-flow anesthesia. Using guided, simulation-based learning, basic concepts of low-flow anesthesia are explored along with strategies for reducing fresh gas flow during the induction, maintenance and emergence phases of inhalation anesthesia. APSF Course on low-flow
- Health Sector commitments to lowering GHG emissions Health Sector Climate Pledge
Optional Resources
Links
- The U.S. health care industry is one of the world’s worst polluters, causing many of the deaths it seeks to prevent. Opinion: Hospitals and Public Health
Risks and mitigations
Risk | Mitigation |
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Anesthesia providers not adopting new practice | Consistent messaging from early adopters and leadership in support of practice change |
About
Origin story
Original team
Samuel Smith, CRNA
Nurse Anesthetist
Comment
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