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Abbott Z, Parks K, Meron A. The hidden cost of chronic pain: A narrative review of the environmental impact of outpatient spine and musculoskeletal care. PM R 2024. [PMID: 38989635 DOI: 10.1002/pmrj.13219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/26/2024] [Accepted: 05/02/2024] [Indexed: 07/12/2024]
Abstract
Health care is a major driver of greenhouse gas emissions and is closely intertwined with industrial processes responsible for air, water, and soil pollution. Chronic pain - particularly as it relates to spine and musculoskeletal diagnoses - comprises a significant portion of health care utilization and affects millions of people worldwide. Despite the prevalence of chronic spine and musculoskeletal pain, there has been limited discussion of the environmental impacts of outpatient clinics and interventional processes as they relate to these conditions. This narrative review explores the environmental impact related to diagnostics, pharmacologics, and common nonoperative interventional procedures utilized in the management of patients with chronic musculoskeletal and spine pain. Topics explored include energy utilization, production and disposal of pharmaceuticals, and waste production from interventional procedures. This study aims to educate providers involved in spine and musculoskeletal disease management regarding the possible environmental consequences of their practices. The article also focuses on modifying approaches to patient care to those that are more sustainable as well as highlighting areas in need of further investigation.
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Affiliation(s)
- Zachary Abbott
- University of Colorado, School of Medicine Department of Physical Medicine and Rehabilitation, Aurora, Colorado, USA
| | - Kaden Parks
- University of Colorado, School of Medicine Department of Physical Medicine and Rehabilitation, Aurora, Colorado, USA
| | - Adele Meron
- University of Colorado, School of Medicine Department of Physical Medicine and Rehabilitation, Aurora, Colorado, USA
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2
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Or Z, Seppänen AV. The role of the health sector in tackling climate change: A narrative review. Health Policy 2024; 143:105053. [PMID: 38537397 DOI: 10.1016/j.healthpol.2024.105053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
Abstract
Climate change is one of the largest threats to population health and has already affected the ecosystem, food production, and health and wellbeing of populations all over the world. The healthcare sector is responsible for around 5 % of greenhouse gas emissions worldwide and can play a key role in reducing global warming. This narrative review summarized the information on the role of healthcare systems in addressing climate change and strategies for reducing its negative impact to illustrate different types of actions that can support the ecological transformation of healthcare systems to help reaching sustainable development goals. A wide range of green interventions are shown to be effective to reduce the carbon footprint of healthcare and can have a meaningful impact if implemented systematically. However, these would not suffice unless accompanied by systemic mitigation strategies altering how healthcare is provided and consumed. Sustainable healthcare strategies such as reducing waste and low-value care will have direct benefits for the environment while improving economic and health outcomes. The healthcare sector has a unique opportunity to leverage its position and resources to provide a comprehensive strategy for fighting climate change and improving population health and the environment on which it depends.
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Affiliation(s)
- Zeynep Or
- Institut de recherche et documentation en économie de la santé (IRDES), France.
| | - Anna-Veera Seppänen
- Institut de recherche et documentation en économie de la santé (IRDES), France
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3
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Guirado-Fuentes C, Abt-Sacks A, Trujillo-Martín MDM, García-Pérez L, Rodríguez-Rodríguez L, Carrion i Ribas C, Serrano-Aguilar P. Main Challenges of Incorporating Environmental Impacts in the Economic Evaluation of Health Technology Assessment: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4949. [PMID: 36981859 PMCID: PMC10049058 DOI: 10.3390/ijerph20064949] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Health technology assessment (HTA) provides evidence-based information on healthcare technology to support decision making in many countries. Environmental impact is a relevant dimension of a health technology's value, but it has been poorly addressed in HTA processes in spite of the commitment that the health sector must have to contribute to mitigating the effects of climate change. This study aims to identify the state of the art and challenges for quantifying environmental impacts that could be incorporated into the economic evaluation (EE) of HTA. We performed a scoping review that included 22 articles grouped into four types of contribution: (1) concepts to draw up a theoretical framework, (2) HTA reports, (3) parameter designs or suitable indicators, and (4) economic or budgetary impact assessments. This review shows that evaluation of the environmental impact of HTAs is still very incipient. Small steps are being taken in EE, such as carbon footprint estimations from a life-cycle approach of technologies and the entire care pathway.
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Affiliation(s)
- Carmen Guirado-Fuentes
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Santa Cruz de Tenerife, Spain
- Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute, 28029 Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Santa Cruz de Tenerife, Spain
| | - Analía Abt-Sacks
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Santa Cruz de Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Santa Cruz de Tenerife, Spain
| | - María del Mar Trujillo-Martín
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Santa Cruz de Tenerife, Spain
- Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute, 28029 Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Santa Cruz de Tenerife, Spain
- Institute of Biomedical Technologies (ITB), University of La Laguna, 38200 San Cristobal de La Laguna, Spain
| | - Lidia García-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Santa Cruz de Tenerife, Spain
- Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute, 28029 Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Santa Cruz de Tenerife, Spain
- Institute of Biomedical Technologies (ITB), University of La Laguna, 38200 San Cristobal de La Laguna, Spain
| | | | - Carme Carrion i Ribas
- Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute, 28029 Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Santa Cruz de Tenerife, Spain
- eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya (UOC), 08035 Barcelona, Spain
| | - Pedro Serrano-Aguilar
- Research Network on Health Services for Chronic Conditions (REDISSEC), Carlos III Health Institute, 28029 Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 38109 Santa Cruz de Tenerife, Spain
- Institute of Biomedical Technologies (ITB), University of La Laguna, 38200 San Cristobal de La Laguna, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 Santa Cruz de Tenerife, Spain
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Maharaj S, Moonilal M, Jankie S, Dookeram D. Pharmacist Rethink through a Planetary Health Lens. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211020885. [PMID: 34088229 PMCID: PMC8182178 DOI: 10.1177/00469580211020885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Planetary Health is a rapidly developing field that is gaining momentum and significance as the world grapples with the devastating effects of infectious diseases, climate change, biodiversity loss, complex food insecurities, and international competition for resources. These challenges are often attributable to the financial activity made by nation states and increasing disposable individual wealth. The outcomes have created a perfect storm of events that, if not managed properly, threatens the health of current and future generations. Given the front-line role pharmacists play within health system in the community and institutional levels, the profession is uniquely positioned to make a meaningful impact to planetary health. This article aims to explore contributions pharmacists can make to secure planetary health.
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Affiliation(s)
- Sandeep Maharaj
- Planetary Health Alliance, Boston, MA, USA.,The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Mala Moonilal
- Hyper Pharm Pharmacy, St. Joseph, Trinidad and Tobago
| | - Satish Jankie
- The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Darren Dookeram
- The University of the West Indies, St. Augustine, Trinidad and Tobago.,Sangre Grande Hospital, Eastern Regional Health Authority, Trinidad and Tobago
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5
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Allwright E, Abbott RA. Environmentally sustainable dermatology. Clin Exp Dermatol 2021; 46:807-813. [PMID: 33215752 DOI: 10.1111/ced.14516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/20/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022]
Abstract
In 2017, health and social care organizations contributed 6.3% of carbon emissions in England. Efforts to reduce the environmental footprint of the National Health Service (NHS) have been broadly focused on reducing demand, through prevention and patient empowerment, and modifying supply side factors by focusing on lean care systems and low carbon alternatives. This narrative review concentrates on supply side factors to identify sustainable practices with a focus on actions that could be implemented in dermatology departments. For this study, a literature review was conducted In MEDLINE in April 2020. The search terms included 'environmental sustainability' and 'climate change' with 'dermatology', 'telemedicine', 'NHS', 'surgery' and 'operating theatres'. Out of 95 results, 20 were deemed relevant to the review. Although the review showed that there is clearly growing interest in environmental sustainability, the identified literature lacked examples of comprehensive implementation and evaluation of initiatives. The literature discussed distinct areas including transport, waste management and procurement as part of a lean healthcare system. A number of papers highlighted the potential contribution of carbon-reducing actions without citing verifiable outcome data. This narrative review highlights the need for detailed environmental impact assessments of treatment options in dermatology, in tandem with economic analysis. In conclusion, we have identified a clear need for evidence-based guidance setting out implementable actions with identifiable benefits achievable within local clinical teams. This will require engagement between clinicians, patients and healthcare organizations.
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Affiliation(s)
- E Allwright
- School of Medicine, Cardiff University, Cardiff, UK
| | - R A Abbott
- Department of Dermatology, University Hospital of Wales, Cardiff, UK
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Taylor T, Mackie P. Carbon footprinting in health systems: one small step towards planetary health. Lancet Planet Health 2017; 1:e357-e358. [PMID: 29851647 DOI: 10.1016/s2542-5196(17)30158-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 06/08/2023]
Affiliation(s)
- Tim Taylor
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, RCH Treliske, Truro, UK.
| | - Phil Mackie
- Scottish Public Health Network/Scottish Managed Sustainable Health Network, Edinburgh, UK
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7
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Chen M, Zhou R, Du C, Meng F, Wang Y, Wu L, Wang F, Xu Y, Yang X. The carbon footprints of home and in-center peritoneal dialysis in China. Int Urol Nephrol 2016; 49:337-343. [PMID: 27848064 DOI: 10.1007/s11255-016-1418-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/08/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The provision of healthcare itself is associated with abundant greenhouse gas (GHG) emissions. This study aims to determine the carbon footprints of peritoneal dialysis (PD) with the different modalities and treatment regimes. METHODS A total of 68 subjects performed with PD treatment were enrolled in this study. Emissions factors were applied to data that were collected for energy consumption, travel, and procurement. RESULTS The carbon footprints generated by the provision of PD treatment for the individual patient were calculated and normalized to a 2-l PD dialysate volume. The fixed emissions were higher in patients who received PD therapy in center than at home, mostly attributing to the consumption of electricity. Conversely, PD treatment performed in center yielded less variable emissions than that of at home, which resulted from reduced constituent percentage of waste disposal and transportation. Collectively, packaging consumption mostly contributed to the total carbon footprints of PD. CONCLUSION This study for the first time demonstrates the delivery of PD is associated with considerable GHG emissions, which is mainly attributed to packaging materials, transportation, electricity, and waste disposal. These results suggest that carbon reduction strategies focusing on packaging consumption in PD treatment are likely to yield the greatest benefits.
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Affiliation(s)
- Mindong Chen
- Department of Nephrology, Yangpu Hospital, Tongji University, Shanghai, 200090, China
| | - Rong Zhou
- Department of Nephrology, Yangpu Hospital, Tongji University, Shanghai, 200090, China
| | - Chongbo Du
- Department of Intensive Care Unit, The First Hospital of Hebei Medical University, No 89 Donggang Road, Shijiazhuang, 050030, Hebei, China
| | - Fulei Meng
- Department of Intensive Care Unit, The First Hospital of Hebei Medical University, No 89 Donggang Road, Shijiazhuang, 050030, Hebei, China
| | - Yanli Wang
- Department of Intensive Care Unit, The First Hospital of Hebei Medical University, No 89 Donggang Road, Shijiazhuang, 050030, Hebei, China
| | - Liping Wu
- Department of Intensive Care Unit, The First Hospital of Hebei Medical University, No 89 Donggang Road, Shijiazhuang, 050030, Hebei, China
| | - Fang Wang
- Department of Intensive Care Unit, The First Hospital of Hebei Medical University, No 89 Donggang Road, Shijiazhuang, 050030, Hebei, China
| | - Yahong Xu
- Department of Nephrology, Yangpu Hospital, Tongji University, Shanghai, 200090, China
| | - Xiufen Yang
- Department of Intensive Care Unit, The First Hospital of Hebei Medical University, No 89 Donggang Road, Shijiazhuang, 050030, Hebei, China.
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Woods DL, McAndrew T, Nevadunsky N, Hou JY, Goldberg G, Yi-Shin Kuo D, Isani S. Carbon footprint of robotically-assisted laparoscopy, laparoscopy and laparotomy: a comparison. Int J Med Robot 2015; 11:406-12. [DOI: 10.1002/rcs.1640] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 12/16/2014] [Accepted: 12/18/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Demetrius L. Woods
- Emory University School of Medicine; Department of Obstetrics and Gynecology; Emory Midtown Hospital Atlanta GA 30308 USA
| | - Thomas McAndrew
- Albert Einstein College of Medicine; Division of Gynecologic Oncology, Montefiore Medical Center, Department of Obstetrics and Gynecology and Women's Health; Bronx NY USA
| | - Nicole Nevadunsky
- Albert Einstein College of Medicine; Division of Gynecologic Oncology, Montefiore Medical Center, Department of Obstetrics and Gynecology and Women's Health; Bronx NY USA
| | - June Y. Hou
- Albert Einstein College of Medicine; Division of Gynecologic Oncology, Montefiore Medical Center, Department of Obstetrics and Gynecology and Women's Health; Bronx NY USA
| | - Gary Goldberg
- Albert Einstein College of Medicine; Division of Gynecologic Oncology, Montefiore Medical Center, Department of Obstetrics and Gynecology and Women's Health; Bronx NY USA
| | - Dennis Yi-Shin Kuo
- Albert Einstein College of Medicine; Division of Gynecologic Oncology, Montefiore Medical Center, Department of Obstetrics and Gynecology and Women's Health; Bronx NY USA
| | - Sara Isani
- Robert Wood Johnson Medical School; Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science; New Brunswick NJ USA
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Thiel CL, Eckelman M, Guido R, Huddleston M, Landis AE, Sherman J, Shrake SO, Copley-Woods N, Bilec M. Environmental impacts of surgical procedures: life cycle assessment of hysterectomy in the United States. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2015; 49:1779-86. [PMID: 25517602 PMCID: PMC4319686 DOI: 10.1021/es504719g] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 05/25/2023]
Abstract
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.
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Affiliation(s)
- Cassandra L. Thiel
- Department
of Civil and Environmental Engineering, University of Pittsburgh, 153 Benedum Hall, 3700 O’Hara Street, Pittsburgh, Pennsylvania 15261, United States
| | - Matthew Eckelman
- Department
of Civil and Environmental Engineering, Northeastern University, 360 Huntington Avenue, Boston, Massachusetts 02115, United States
| | - Richard Guido
- Magee-Womens Hospital
of UPMC, Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, Pennsylvania 15213, United States
| | - Matthew Huddleston
- Department
of Civil and Environmental Engineering, University of Pittsburgh, 153 Benedum Hall, 3700 O’Hara Street, Pittsburgh, Pennsylvania 15261, United States
| | - Amy E. Landis
- School
of Sustainable Engineering and the Built Environment, Arizona State University P.O. Box 875306, Tempe, Arizona 85287, United States
| | - Jodi Sherman
- Department
of Anesthesiology, Yale University School
of Medicine, 333 Cedar
Street, TMP 3, New Haven, Connecticut 06520, United States
| | - Scott O. Shrake
- School
of Sustainable Engineering and the Built Environment, Arizona State University P.O. Box 875306, Tempe, Arizona 85287, United States
| | - Noe Copley-Woods
- Magee-Womens Hospital
of UPMC, Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, Pennsylvania 15213, United States
| | - Melissa
M. Bilec
- Department
of Civil and Environmental Engineering, University of Pittsburgh, 153 Benedum Hall, 3700 O’Hara Street, Pittsburgh, Pennsylvania 15261, United States
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10
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Carbon mitigation, patient choice and cost reduction – triple bottom line optimisation for health care planning. Public Health 2014; 128:920-4. [DOI: 10.1016/j.puhe.2014.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 06/12/2014] [Accepted: 08/06/2014] [Indexed: 11/17/2022]
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Pollard AS, Paddle JJ, Taylor TJ, Tillyard A. The carbon footprint of acute care: how energy intensive is critical care? Public Health 2014; 128:771-6. [PMID: 25192883 DOI: 10.1016/j.puhe.2014.06.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 05/14/2014] [Accepted: 06/12/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Climate change has the potential to threaten human health and the environment. Managers in healthcare systems face significant challenges to balance carbon mitigation targets with operational decisions about patient care. Critical care units are major users of energy and hence more evidence is needed on their carbon footprint. STUDY DESIGN The authors explore a methodology which estimates electricity use and associated carbon emissions within a Critical Care Unit (CCU). METHODS A bottom-up model was developed and calibrated which predicted the electricity consumed and carbon emissions within a CCU based on the type of patients treated and working practices in a case study in Cornwall, UK. RESULTS The model developed was able to predict the electricity consumed within CCU with an error of 1% when measured against actual meter readings. Just under half the electricity within CCU was used for delivering care to patients and monitoring their condition. CONCLUSIONS A model was developed which accurately predicted the electricity consumed within a CCU based on patient types, medical devices used and working practice. The model could be adapted to enable it to be used within hospitals as part of their planning to meet carbon reduction targets.
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Affiliation(s)
- A S Pollard
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, RCH Treliske, Truro TR1 3HD, UK; Royal Cornwall Hospitals NHS Trust, Truro TR1 3LJ, Cornwall, UK; Pollard Systems Ltd, Mevagissey, Cornwall PL26 6TL, UK
| | - J J Paddle
- Royal Cornwall Hospitals NHS Trust, Truro TR1 3LJ, Cornwall, UK
| | - T J Taylor
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, RCH Treliske, Truro TR1 3HD, UK.
| | - A Tillyard
- Royal Cornwall Hospitals NHS Trust, Truro TR1 3LJ, Cornwall, UK
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