Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia.
BMJ Open Qual. 2022 Aug;11(3). doi: 10.1136/bmjoq-2022-001867.
Sustainability interventions were implemented at the Royal Brisbane and Women's Hospital (RBWH) following identification of inhaled anaesthetic gases as a target for reducing medical carbon emissions. This quality improvement study assessed and evaluated the impact of sustainability interventions on the environmental and financial cost of inhaled anaesthetic gas use in order to guide future initiatives and research in reducing carbon emissions from healthcare practice.Ethical exemption was granted from the RBWH Research Ethics Committee (EX/2021/QRBW/76078). Usage (bottles) and expenditure for desflurane and sevoflurane from January 2016 to December 2021 were obtained. Global warming potential and carbon dioxide equivalent (COe) were used to report environmental impact of volatile agents. Methods to estimate this were performed in Excel based on Campbell and Pierce methodology. An Environmental Protection Agency greenhouse gas equivalency calculator was used to convert COe to equivalent petrol carbon emissions and kilometres travelled by a typical passenger vehicle.The total number of bottles of sevoflurane and desflurane purchased between January 2016 and December 2021 decreased by 34.76% from 1991 to 1299. The number of desflurane bottles purchased decreased by 95.63% from 800 to 35 bottles. The number of sevoflurane bottles purchased increased by 6.13% from 1191 bottles to 1264 bottles. This was achieved by implementing quality improvement interventions such as staff education of desflurane-sparing practices, distribution of posters and progressive removal of desflurane from operating theatres. Total carbon emission from volatile anaesthetics equalled 2326 tonnes COe. Combined desflurane and sevoflurane emissions decreased by 87.88%. In 2016, desflurane made up 92.39% of the annual COe, which steadily decreased to 33.36% in 2021. Combined sevoflurane and desflurane usage costs decreased by 58.33%.Substantial reductions in carbon emissions from volatile anaesthetics demonstrate the significant degree to which environmentally sustainable practices have been implemented. Applying desflurane-sparing practice can heavily limit anaesthetic drug expenditure and contribution to environmental waste. This is important given the global health sector's challenge to optimise patient outcomes in the face of global climate change crisis.
在确定吸入麻醉气体是减少医疗碳排放的目标后，皇家布里斯班妇女医院（RBWH）实施了可持续性干预措施。这项质量改进研究评估和评估了可持续性干预措施对吸入麻醉气体使用的环境和财务成本的影响，以便为减少医疗实践中的碳排放提供未来的举措和研究方向。RBWH 研究伦理委员会（EX/2021/QRBW/76078）豁免了研究的伦理审查。从 2016 年 1 月至 2021 年 12 月，获得了地氟烷和七氟烷的使用量（瓶）和支出。使用全球变暖潜能值和二氧化碳当量（COe）来报告挥发性麻醉剂的环境影响。使用基于 Campbell 和 Pierce 方法学的 Excel 方法来估算这一点。使用美国环境保护署温室气体当量计算器将 COe 转换为等效汽油碳排放量和典型乘用车行驶的公里数。2016 年 1 月至 2021 年 12 月期间购买的地氟烷和七氟烷瓶总数减少了 34.76%，从 1991 年减少到 1299 年。地氟烷瓶的购买量减少了 95.63%，从 800 年减少到 35 年。七氟烷瓶的购买量增加了 6.13%，从 1191 年增加到 1264 年。这是通过实施质量改进干预措施实现的，例如对地氟烷节约实践的员工教育、张贴海报和逐步从手术室中去除地氟烷。挥发性麻醉剂的总碳排放量相当于 2326 吨 COe。地氟烷和七氟烷的排放量合计减少了 87.88%。2016 年，地氟烷占年度 COe 的 92.39%，这一比例稳步下降到 2021 年的 33.36%。地氟烷和七氟烷的总使用成本减少了 58.33%。挥发性麻醉剂的碳排放大量减少表明，在环境可持续性实践方面已经取得了显著的进展。应用地氟烷节约实践可以大大限制麻醉药物的支出和对环境废物的贡献。这一点很重要，因为全球卫生部门面临着在全球气候变化危机面前优化患者治疗效果的挑战。
