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Less Gas More Green

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To 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.

This innovation is replicating across multiple facilities as its impact continues to be validated. See more replicating innovations.

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

Contact Team

Overview

Problem

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 t
... See more

Images

Estimated cost and CO2 impact of common practices

Estimated cost and CO2 impact of alternative practices

Videos

Climate action is speeding up -- and we each have the power to push that transformation forward. As the head of the UNFCCC, the UN's entity supporting the global response to climate change, Simon Stiell points to clear social and technological signals that show we're at the tipping points of a green revolution -- and invites us all to apply our unique skills to defending the planet against the catastrophic impacts of the climate crisis

Solution

To 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 provider are sometimes resis ... See more

Videos

Respiratory gas conditioning is important to protect the lungs and is a universal standard of care. Cold and dry respiratory gases reduce ciliary activity in the respiratory epithelium. The reduction of mucociliary clearance can lead to atelectasis and infections, conditions referred to as postoperative pulmonary complications. Various studies demonstrated, that protective ventilation approaches allow the reduction in incidence of postoperative pulmonary complications (PPC). Warming and humidifying the respiratory gases using low-flow anaesthesia can reduce these negative effects on the respiratory epithelium

Anesthesia providers can set targets for end-tidal oxygen (EtO2) and end-tidal anesthetic agent (EtAA), and the Et Control software2 will automatically and efficiently adjust fresh gas concentrations to quickly achieve and maintain these targets, even with changes in the patient’s hemodynamic and metabolic status. Providers can switch to manual fresh gas control at any time. Safety mechanisms help maintain targets, so providers can practice low-flow anesthesia with confidence.

The ecoFLOW feature shows how much anesthetic agent is being consumed and shows the anesthetic agent costs associated with each case. This features allows providers to track agent costs, helps support low-flow anesthesia practices and may help hospitals achieve their sustainability goals in reducing greenhouse gas emissions

The Circle Breathing System Explained in under 2 minutes

Results

Richmond VAMC experienced a cost avoidance of approximately $10,000 with the lowering of fresh gas flows. Additionally, avoidance of Desflurane saved an additional $5000.
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)

Statuses

FL: Orlando VA Medical Center (Orlando)
  • Started adoption on 07/2024.
GA: Augusta VA Medical Center-Uptown (Augusta Uptown)
  • Started adoption on 04/2024.
NC: Durham VA Medical Center (Durham)
  • Started adoption on 04/2024.
VA: Richmond VA Medical Center (Richmond, Virginia)
  • Started adoption on 04/2023.

There are no unsuccessful adoptions for this innovation.

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
PEOPLE
  • CRNA Champion: 1-2 hours per week for 1-2 months to establish program; then, 3-4 hours per month for 3-6 months to review relevant metrics
PROCESSES
  • Diffusion Marketplace Less Gas More Green Guide to Low Flow Anesthesia
TOOLS
  • QR-linked methodology for low flow anesthesia

Files

Links

Optional Resources

Links

Risks and mitigations

Risk Mitigation
Anesthesia providers not adopting new practice Consistent messaging from early adopters and leadership in support of practice change

Contact

Comment

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Email

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About

Origin story

This innovation was developed after watching a successful deployment of this methodology in private practice anesthesia; however, I saw some opportunities for refinement and meaningful engagement with the most important stakeholder in this conversation, the anesthesia provider. To truly create meaningful and lasting practice change, I had to engage providers ... This innovation was developed after watching a successful deployment of this methodology in private practice anesthesia; however, I saw some opportunities for refinement and meaningful engagement with the most important stakeholder in this conversation, the anesthesia provider. To truly create meaningful and lasting practice change, I had to engage providers by influencing their feelings. This is at the heart of human-centered design, and helped me to avoid "rolling over" with the "roll out".

Original team

Samuel Smith, CRNA

Nurse Anesthetist