Carbon footprint reduction associated with a surgical outreach clinic

Environmental sustainability in gynecologic oncology

Climate change is a complex, global issue that is impacting human health in various ways, with healthcare being a significant contributor to carbon emissions in the United States. This review discusses the environmental impact of important aspects of gynecologic oncology care, including surgery, anesthesia care, radiology, chemotherapy, and radiation oncology. Operating room energy and material use is highlighted, with a focus on the environmental impact of robotic surgery. The contribution of certain anesthetic gases in increasing greenhouse gas emissions is addressed. Additionally, the environmental impacts of radiologic imaging, chemotherapy, and radiation oncology are also discussed. Despite the complexity of climate change, there are multiple strategies on the individual and institutional level that can help mitigate the environmental impact of gynecologic oncology care. Individual efforts include practicing red bag stewardship, limiting single use-supplies, decreasing the use of potentially deleterious anesthetics, and supporting research into alternative dosing for chemotherapy and radiation which requires less patient travel. Institutional strategies include investing in efficient HVAC systems, utilizing reusable and reprocessed materials and devices, and purchasing renewable energy sources. Both individuals and institutions can advocate with industry and government at all levels for practices and policies that support lower carbon emissions. By recognizing our role in reducing carbon emissions, we can work towards improving the well-being of our patients and the larger community.

Improving Access to Care, Patient Costs, and Environmental Impact Through a Community Outreach Lung Cancer Rapid Assessment Clinic

PURPOSE

In Southeastern Ontario, increased patient distance from the regional lung cancer diagnostic assessment program (LDAP) is associated with a lower likelihood of patient care via LDAP while receiving care via LDAP is associated with improved survival. We implemented an LDAP outreach clinic to provide specialist assessment for patients with suspected lung cancer at a regional community hospital and assessed the impact on timeliness and accessibility of care.

MATERIALS AND METHODS

The Kingston Health Sciences Centre LDAP team engaged with community hospital partners to develop and launch the LDAP outreach clinic. We performed a retrospective chart review of LDAP patients (N = 1,070) before (August-November 2021; n = 234) and after implementation of the outreach clinic (November 2021-October 2022; n = 836). Descriptive data are reported as No. (%). Unpaired t tests and statistical process control charts assess for significance. A cost analysis of out-of-pocket patient costs related to travel and parking is presented in 2022 Canadian dollars (CAD).

RESULTS

Compared with a 3-month matched time period before (August-October 2021) and after outreach clinic (August-October 2022), the mean time from referral to assessment and time from referral to diagnosis decreased from 20.3 to 14.4 days (P = .0019) and 40.0 to 28.9 days (P = .0007), respectively. Over 12 months, the total patient travel was reduced by 8,856 km, which combined with parking cost-savings, resulted in patient out-of-pocket savings of CAD $5,755.60 (CAD $47.60/patient). Accounting for physician travel, the total travel saved was 5,688 km, corresponding to reduced CO2 emissions by 1.9 tCO2.

CONCLUSION

Implementation of a lung cancer outreach clinic led to improved timeliness of care, patient cost-savings, and reduced carbon footprint while serving patients in their community.

Carbon Footprint Reduction Associated With Multidisciplinary Pediatric Airway Clinics: A Program Evaluation Study

Objective

Health care is a significant contributor to the climate crisis. Multidisciplinary clinics (MDC) may reduce carbon emissions by combining multiple appointments into one. This is the first program evaluation study to quantify the carbon footprint associated with multidisciplinary pediatric airway clinics.

Study Design

Retrospective.

Setting

Children's Hospital at London Health Sciences Center, London, Canada.

Methods

Pediatric airway MDC allows patients to see otolaryngology and respirology in one appointment. The carbon and financial savings (Canadian Dollars) of all patients attending the MDC from January 1, 2018 to December 31, 2022 were calculated. Patient postal codes and institutional parking rates were inputted into the CASCADES carbon accounting tool. Total distance was divided into unsustainable (vehicles) and sustainable (transit, walking, cycling) transportation to calculate carbon emissions. Travel costs included cost/kilometer for vehicles (maintenance, license/registration, insurance, fuel) and costs/ride for transit.

Results

A total of 560 MDC appointments for 300 patients saved 77,785 km. Total carbon emissions saved from travel averted was 16.21 tonnes. The total carbon emissions saved, minus public transit, was 15.60 tonnes. Using the Natural Resources Canada Greenhouse Gas Equivalencies Calculator, 16.21 tonnes are approximately equivalent to 5 passenger vehicles, 6906 L of gasoline, 3.8 homes' energy, and 10.8 homes' electricity use for one year, 36.6 barrels of oil consumed, and 675 propane cylinders. Travel costs of $28,891.83 (no parking), $30,519.40 ($4 minimum parking fee), or $33,774.55 ($12 maximum parking fee) were saved.

Conclusion

MDC effectively reduced carbon emissions and offered patients financial savings. Similar models can be adapted across institutions to help mitigate climate change.

Delivering a net zero National Health Service: where does otorhinolaryngology - head and neck surgery stand?

OBJECTIVE

The National Health Service (NHS) recognised the risk to public health brought by climate change by launching the Greener NHS National Programme in 2020. These organisational changes aim to attain net zero direct carbon emissions. This article reviews the literature on initiatives aimed at mitigating the environmental impact of ENT practice.

METHOD

Systematic review of the literature using scientific, healthcare and general interest (public domain) databases.

RESULTS

The initiatives reviewed can be broken down into strategies for mitigating the carbon footprint of long patient stay, use of operative theatres and healthcare travel. The carbon footprint of in-patient stay can be mitigated by a shift towards day-case surgery. The ENT community is currently focused on the reduction of theatre waste and the use of disposable instruments. Furthermore, supply chains and healthcare delivery models are being redesigned to reduce travel.

CONCLUSION

Future areas of development include designing waterless theatre scrubs, waste-trapping technologies for anaesthetic gases and a continuing investment in virtual healthcare.

A sustainable scheduling system for medical equipment: Towards net zero goals for green healthcare

Shortages of medical equipment, growth in medical waste and carbon emissions have increased healthcare pressures and has a huge impact on the environment. An efficient scheduling of medical equipment will effectively reduce the pressure on healthcare and improve the healthcare system's ability to respond to unexpected disasters. A medical equipment scheduling system was established to improve the sustainable utilization of medical equipment within the healthcare network and to reduce the carbon emissions of the healthcare process. First, this paper combines medical equipment information to establish a medical equipment scheduling decision model that considers pollution to filter qualified medical equipment for scheduling. Then, this paper constructs and solves a multi-objective robust optimization model by collecting the patient's travel information and the medical pressure information of each region. In addition, to meet dynamic healthcare needs, a dynamic medical equipment configuration framework was constructed to enhance the flexibility of equipment scheduling and the resilience of the healthcare network. Combined with case studies, the results show that the medical equipment scheduling system can help decision makers make quick scheduling decisions and achieve sustainable use of medical equipment, with a corresponding increase in medical equipment utilization of 12.25% and a reduction in carbon emissions of 26.50%. The study will help enhance healthcare resource utilization and contribute to the net-zero goal of green healthcare.

Factors contributing to the carbon footprint of cataract surgery

The healthcare sector is a significant greenhouse gas emitter. Cataract surgery is a procedure that results in a large amount of carbon dioxide (CO2) emissions. We sought to review the literature for factors contributing to the carbon footprint of this procedure. The literature, although limited, varies greatly by region. The carbon footprint of cataract surgery ranged from approximately 6 kg CO2 equivalents in a center in India to 181.9 kg CO2 equivalents in a center in the United Kingdom. Factors contributing to the carbon footprint of cataract surgery included the procurement of materials, energy use, and the emissions associated with travel. Factors facilitating a lower carbon footprint include the reuse of surgical materials and more efficient autoclave settings. Potential areas for improvement to consider include the reduction in packaging material, the reuse of materials, and potentially reducing travel emissions by performing simultaneous bilateral cataract surgery.

[Pilot trial on the detection of patients with undiagnosed diabetes mellitus type 2 performed in community pharmacies in Valladolid. Environmental impact evaluation]

Introduction

The complications that DM2 can develop, and the undiagnosed population (6%) highlight the importance of screening at the population level. The aim of this work is to evaluate and verify whether the professional activity performed in pharmacies is a good point to detect patients with undiagnosed type 2 diabetes mellitus and to refer them for a possible diagnosis. Moreover, to evaluate the environmental impact of the actions.

Methodology

Findrisc questionnaire for patients who met the inclusion criteria and agreed to participate in the study. Basal capillary blood glucose measurement if the result was ≥15 points and referral to a physician if blood glucose was ≥110mg/dL.

Results

44 pharmacies participated. The sample included 434 users; those with high or very high risk (Findrisc ≥15) underwent capillary basal glycemia, with a mean result of 124.51 mg/dL (SD=33.6). Out of the 89 patients referred to the physician (20.5%), the patients diagnosed with diabetes type 2 accounted for 3% of the analyzed sample.

Conclusions

The number of newly diagnosed patients (3%) reflects that the community pharmacy is a good place for diabetes detection. In addition, the study reveals pharmacists' usefulness in their role as a health educator, since they provide guidance on healthy lifestyle habits to those patients not subject to physician referral. Furthermore, closer collaborations between physicians and pharmacists would be necessary in diabetes screening, since the return of information was low; although we can observe that in rural areas, where the relationship is close, the return rate was 85.2%.

Low-Carbon Action in Full Swing: A Study on Satisfaction with Wise Medical Development

The development of "wise medical" is crucial to global carbon reduction. The medical sector not only has the moral obligation to reduce carbon emissions, but also has the responsibility to provide high-quality services to patients. Existing research mostly focuses on the relationship between low-carbon and wise medical, while ignoring the transformation of wise medical and patients' opinions in the context of low-carbon transition. The paper crawls the text data of comments on the Zhihu platform (a Chinese platform similar to Quora), explores the focus of patients on wise medical through the co-occurrence analysis of high-frequency words, with a focus directly related to the role of wise medical treatment in carbon reduction, and designed a questionnaire accordingly. Using 837 valid questionnaires collected in Zhejiang Province, an XGBoost model was constructed to discuss the main factors affecting patient satisfaction, and the regional heterogeneity among the coastal area of eastern Zhejiang, the plain area of northern Zhejiang and the mountainous area of southwestern Zhejiang is discussed. The results show that patients' focus on wise medical lies mainly in the convenience brought by digitalization and the actual medical effect, and the main factors affecting satisfaction with medical treatment are the flow of people in hospitals, optimization of the medical treatment process, the application of digital platforms, the quality of telemedicine services and the appropriate quality of treatment. In terms of regional differences in Zhejiang Province, wise medical is more developed in the plain area of northern Zhejiang, with better simplified medical treatment processes and the construction of a digital platform, while the mountainous areas of southwestern Zhejiang have better quality in telemedicine services despite the geographical environment. Eastern Zhejiang is somewhere in between.