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Raurell-Torredà M, Fernández-Castillo RJ, Rodríguez-Delgado ME, Cobos-Vargas Á, Achury-Saldaña DM, Cavallo E, Muriel-García A, Arias-Rivera S. Blood-sparing techniques prevalence in adult intensive care units: A multicentre survey study. ENFERMERIA INTENSIVA 2024:S2529-9840(24)00041-7. [PMID: 39317605 DOI: 10.1016/j.enfie.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/01/2024] [Indexed: 09/26/2024]
Abstract
INTRODUCTION Anaemia is a common condition in patients admitted to intensive care units (ICUs). It is also well known that a significant amount of the carbon dioxide produced by health services is likely attributable to blood donation, testing, and the manufacture, storage, and distribution of blood components. To mitigate this, prevention strategies such as blood-sparing techniques are available. There is a lack of knowledge regarding the use of such techniques in ICUs in Spain and Latin America, healthcare systems with very different health expenditures per capita. The aim is to assess the degree of implementation of blood-sparing techniques in these regions. METHODS Cross-sectional online multicentre survey. 251 ICUs in Spain and 53 in Latin America (20 in Argentina, 20 in Colombia, 13 in Ecuador) participated. A 20-item survey on the use of point-of-care, small-volume tubes (SVT), and closed-blood sampling devices (CBSD) was validated. Effect sizes were calculated using Phi (φ) or Cramer's V (V). RESULTS A response rate of 77% was obtained for Spain and 96% for Latin America. In Spain, the majority of ICUs were affiliated with public hospitals (88.1%, 171/194) while in Latin America, most were associated with private hospitals (56.9%, 29/51). Regarding the use of point-of-care testing, 67.5% of Spanish ICUs, compared to 35.3% of Latin Americans, reported frequent use (V=0.343). In 91.7% of Spanish ICUs and 58.9% of Latin Americans, SVTs were rarely or never used (V=0.380). The use of CBSD was significantly lower in Spain for both arterial and central venous catheters (V=0.336). Private hospitals used more CBSD in arterial catheter than public ones (27% vs 8.3%, V=0.278). CONCLUSION Point-of-care testing can be improved in Latin America, while the use of CBSD and small-volume tubes can be enhanced in Spain. Private hospitals tend to implement blood-sparing techniques more effectively than public hospitals.
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Affiliation(s)
- M Raurell-Torredà
- Departament d'Infermeria Fonamental i Clínica, Facultat d'Infermeria, Universitat de Barcelona, Barcelona, Spain
| | - R-J Fernández-Castillo
- Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Spain; Unidad de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | - M-E Rodríguez-Delgado
- Unidad de Cuidados Intensivos, Hospital Universitario Clínico San Cecilio, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Á Cobos-Vargas
- Unidad de Cuidados Intensivos, Hospital Universitario Clínico San Cecilio, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - D-M Achury-Saldaña
- Facultad de Enfermería, Pontificia Universidad Javeriana, Coordinadora Red Internacional de Enfermería en Cuidado Crítico, Colombia
| | - E Cavallo
- Facultad de Enfermería, Pontificia Universidad Javeriana, Coordinadora Red Internacional de Enfermería en Cuidado Crítico, Colombia
| | - A Muriel-García
- Unidad de Bioestadística, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Departamento de Enfermería y Fisioterapia, Universidad de Alcalá, Madrid, Spain
| | - S Arias-Rivera
- Departamento de Investigación, Hospital Universitario de Getafe, Madrid, Spain
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Lang TF. Inappropriate Laboratory Testing: The Hidden Cost to the Environment-Time for a Database of Associated Costs. J Appl Lab Med 2024; 9:1070-1072. [PMID: 38776180 DOI: 10.1093/jalm/jfae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/15/2024] [Indexed: 05/24/2024]
Affiliation(s)
- Timothy F Lang
- Consultant Clinical Scientist, Blood Sciences, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
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Pilowsky JK, Lane K, Learmonth G, Walsh O, Scowen C, Williams L, Nguyen N. Environmental impact of a blood test reduction intervention in adult intensive care units: A before and after quality improvement project. Aust Crit Care 2024; 37:761-766. [PMID: 38755050 DOI: 10.1016/j.aucc.2024.03.006] [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: 01/21/2024] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Pathology testing is a very common investigation in the intensive care unit (ICU). Many tests are ordered on a routine basis rather than for a specific clinical indication, resulting in potential patient harm and unnecessary financial and environmental costs. OBJECTIVE The objective of this study was to determine whether a multifaceted intervention based on the principles of education, audit, and feedback can result in a decrease in unnecessary pathology tests without a commensurate increase in adverse patient outcomes and to measure this decrease in terms of the associated reduction in environmental and financial costs. METHODS A before and after quality improvement project was conducted between 2017 and 2019 across four ICUs in three 12-month phases, divided according to baseline, intervention implementation, and follow-up. Local clinician champions from each site partnered with the project coordinating centre to develop and implement a range of interventions based on the principles of education, audit, and feedback. Data were collected for the number of pathology tests performed and the clinical characteristics of patients admitted to a participating ICU across the three phases. RESULTS A total of 196 323 arterial blood gases and 460 258 other tests across eight categories were performed on the 22 210 patients admitted to participating ICUs during the project. A decrease in testing was observed across all but one category, with the greatest reduction seen in arterial blood gases (31.2% reduction in tests per bed-day). Across all categories, this equated to a mean reduction of 1.8 tCO2e (tonnes of carbon dioxide equivalent), a potential estimated total saving of Australian dollar $918 497.50. No increase in adverse clinical outcomes was observed. CONCLUSION A multifaceted intervention based on the principles of education, audit, and feedback can produce a significant decrease in the number of unnecessary pathology tests performed. This reduction translates to substantial environmental and financial savings without any associated increase in adverse patient outcomes.
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Affiliation(s)
- Julia K Pilowsky
- Agency for Clinical Innovation, NSW Health, Australia; University of Sydney, Australia
| | - Kathleen Lane
- Agency for Clinical Innovation, NSW Health, Australia
| | | | | | | | | | - Nhi Nguyen
- Agency for Clinical Innovation, NSW Health, Australia; University of Sydney, Australia; Nepean Hospital, Australia
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Dupraz C, Ducrot C, Allignet B, Delpon G, Alexis A, Lapierre A, Supiot S, Ali D, Piffoux M. The carbon footprint of external beam radiotherapy and its impact in health technology assessment. Clin Transl Radiat Oncol 2024; 48:100834. [PMID: 39211397 PMCID: PMC11359761 DOI: 10.1016/j.ctro.2024.100834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 06/03/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Background The major drivers of carbon dioxide (CO2eq) emissions of external beam radiation therapy (EBRT) are not well known and limit our ability to initiate mitigation strategies. Material and methods We describe the carbon footprint of four typical centers. We explore direct EBRT associated factors such as the impact of fractionation and use of MRI-LINAC, as well as indirect factors (e.g. patient rides). Treatment strategy related CO2eq emissions are included in a health technology assessment analysis that takes into account CO2eq emissions. Results A typical EBRT treatment emits from 185 kgCO2eq to 2066 kgCO2eq. CO2eq emissions are mostly driven by (i) accelerator acquisition and maintenance (37.8 %), (ii) patients and workers rides (32.7 %), (iii) drugs and medical devices (7.3 %), (iv) direct energy consumption (6.1 %), and (v) building and bunker construction (5.6 %) with a substantial heterogeneity among centers. Hypofractionation has a strong impact to mitigate emissions. MRI-LINAC is associated with a substantial increase in CO2eq emissions per fraction and requires ultra hypofractionation in 5 fractions to achieve a similar carbon footprint compared to 20 fractions treatment schemes. The expected limited small increase in toxicities due to hypofractionation (when existing) are in the same range as avoided detrimental effects to future people's health thanks to CO2eq mitigation. Conclusion Carbon footprint of EBRT is not neglectable and could be mitigated. When safely feasible, hypofractionation is one of the main factors to decrease this impact. Taking into account CO2eq emissions has a substantial impact on the health technology assessment of EBRT, favoring hypofractionated regimens.
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Affiliation(s)
- Chloé Dupraz
- Oncologie médicale, Hospices civils de Lyon, France
| | - Coline Ducrot
- Département de Chirurgie Orthopédique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Benoit Allignet
- Département de Chirurgie Orthopédique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Département de radiothérapie, Centre Léon Bérard, Lyon, France
- Univ Lyon, INSA‐Lyon, Université Claude Bernard Lyon 1, Laboratoire CREATIS UMR 5220, U1294 Lyon, France
| | - Gregory Delpon
- Département de Physique Médicale, Institut de Cancérologie de l’Ouest, site Saint-Herblain, France
- Laboratoire SUBATECH, UMR 6457 CNRS-IN2P3, IMT Atlantique, Nantes, France
| | - Anthony Alexis
- Département de Physique Médicale, Institut de Cancérologie de l’Ouest, site Saint-Herblain, France
| | - Ariane Lapierre
- Service de radiothérapie, Hôpital lyon sud, Pierre bénite, France
| | - Stéphane Supiot
- Département de Radiothérapie, Institut de Cancérologie de l’Ouest, site Saint-Herblain, France
- Laboratoire US2B, CNRS UMR 6286, Université de Nantes, Nantes, France
| | - David Ali
- Centre de Radiothérapie de Versailles, France
| | - Max Piffoux
- Oncologie médicale, Hospices civils de Lyon, France
- Direction de la Recherche Clinique et de l’Innovation, Centre Léon Bérard, Lyon, France
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O'Reilly D, Livada A, Steiner L, Drew RJ, Mc Callion N. Beyond the incubator: applying a "one health" approach in the NICU. Pediatr Res 2024:10.1038/s41390-024-03534-4. [PMID: 39215199 DOI: 10.1038/s41390-024-03534-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 08/07/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
A "one health" approach recognises that human health, animal health and planetary health are closely interlinked and that a transdisciplinary approach is required to fully understand and maintain global health. While, by necessity, Neonatal Intensive Care has traditionally focused on the acutely unwell newborn, the avoidance of long-term harm is core to many management decisions. The COVID 19 pandemic and climate crisis have brought into sharp relief the importance of a "one health" approach as part of long-term health promotion in the holistic care of neonates, who may survive to experience the burden of future environmental crises. This narrative review seeks to integrate what we know about "one health" issues in the neonatal intensive care unit, notably antimicrobial resistance and climate change, and suggest "everyday changes" which can be utilised by practitioners to minimise the impact of neonatal intensive care on these global health issues. Many of the changes suggested not only represent important improvements for planetary health but are also core to good neonatal practice. IMPACT: Neonatal patients are likely to bear the burden of future environmental crises including pandemics and climate related disasters. While the focus of intensive care practitioners is acute illness, awareness of "one health" problems are important for our smallest patients as part of preventing long-term harm. High quality neonatal care can benefit both the planet and our patients.
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Affiliation(s)
- Daniel O'Reilly
- Department of Neonatology, Rotunda Hospital, Dublin 1, Ireland.
- School of Biomolecular and Biomedical Science, University College Dublin, Dublin 4, Ireland.
| | - Alison Livada
- Medical Scientist Training Program, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Laurie Steiner
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Richard J Drew
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland
- Clinical Innovation Unit, Rotunda Hospital, Dublin 1, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Naomi Mc Callion
- Department of Neonatology, Rotunda Hospital, Dublin 1, Ireland
- Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
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Thakur A, Mukhopadhyay T, Ahirwar AK. Approaching sustainability in Laboratory Medicine. Clin Chem Lab Med 2024; 62:1787-1794. [PMID: 38557335 DOI: 10.1515/cclm-2023-0973] [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: 09/04/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Clinical laboratories and the total testing process are major consumers of energy, water, and hazardous chemicals, and produce significant amounts of biomedical waste. Since the processes in the clinical laboratory and the total testing process go hand in hand it mandates a holistic, and comprehensive approach towards sustainability. CONTENT This review article identifies the various sources and activities in Laboratory Medicine that challenge sustainability and also discusses the various approaches that can be implemented to achieve sustainability in laboratory operations to reduce the negative impact on the environment. SUMMARY The article highlights how the integration of technological advancements, efficient resource management, staff training and sensitization, protocol development towards sustainability, and other environmental considerations contributes significantly to a sustainable healthcare ecosystem. OUTLOOK Variables and resources that negatively impact the environment must be identified and addressed comprehensively to attain a long-lasting level of carbon neutrality.
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Affiliation(s)
- Anjali Thakur
- Department of Laboratory Medicine, All India Institute Medical Sciences, New Delhi, India
| | - Tapasyapreeti Mukhopadhyay
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute Medical Sciences, New Delhi, India
| | - Ashok Kumar Ahirwar
- Department of Laboratory Medicine, All India Institute Medical Sciences, New Delhi, India
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Sack F, Irwin A, van der Zalm R, Ho L, Celermajer DJ, Celermajer DS. Healthcare-related carbon footprinting-lower impact of a coronary stenting compared to a coronary surgery pathway. Front Public Health 2024; 12:1386826. [PMID: 39234076 PMCID: PMC11371610 DOI: 10.3389/fpubh.2024.1386826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 08/01/2024] [Indexed: 09/06/2024] Open
Abstract
Healthcare is a major generator of greenhouse gases, so consideration of this contribution to climate change needs to be quantified in ways that can inform models of care. Given the availability of activity-based financial data, environmentally-extended input-output (EEIO) analysis can be employed to calculate systemic carbon footprints for healthcare activities, allowing comparison of different patient care pathways. We thus quantified and compared the carbon footprint of two common care pathways for patients with stable coronary artery disease, with similar clinical outcomes: coronary stenting and coronary artery bypass surgery (CABG). Healthcare cost data for these two pathways were disaggregated and the carbon footprint associated with this expenditure was calculated by connecting the flow of money within the economy to the greenhouse gases emitted to support the full range of associated activities. The systemic carbon footprint associated with an average stable patient CABG pathway, at a large tertiary referral hospital in Sydney, Australia in 2021-22, was 11.5 tonnes CO2-e, 4.9 times greater than the 2.4 tonnes CO2-e footprint of an average comparable stenting pathway. These data suggest that a stenting pathway for stable coronary disease should be preferred on environmental grounds and introduces EEIO analysis as a practical tool to assist in health-care related carbon footprinting.
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Affiliation(s)
- Fabian Sack
- Integrated Sustainability Analysis, School of Physics, The University of Sydney, Camperdown, NSW, Australia
| | - Amanda Irwin
- Integrated Sustainability Analysis, School of Physics, The University of Sydney, Camperdown, NSW, Australia
| | - Raymond van der Zalm
- Sydney Environment Institute, The University of Sydney Quadrangle, Camperdown, NSW, Australia
| | - Lorraine Ho
- Performance Monitoring, Systems Improvement and Innovation Unit, Sydney Local Health District, Royal Prince Alfred Hospital, Stanmore, NSW, Australia
| | - Danielle J. Celermajer
- Sydney Environment Institute, The University of Sydney Quadrangle, Camperdown, NSW, Australia
| | - David S. Celermajer
- Faculty of Medicine and Health, Central Clinical School, Heart Research Institute, The University of Sydney, Newtown, NSW, Australia
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Shih P, Sandberg S, Balla J, Basok BI, Brady JJ, Croal B, De Vos N, Karlsson M, Kedars P, Ozben T, Pijanovic M, Plebani M, Orth M. Direct-to-consumer testing as consumer initiated testing: compromises to the testing process and opportunities for quality improvement. Clin Chem Lab Med 2024; 0:cclm-2024-0876. [PMID: 39141796 DOI: 10.1515/cclm-2024-0876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/16/2024]
Abstract
Direct-to-consumer testing (DTCT) refers to commercial laboratory tests initiated by laypersons without the involvement of healthcare professionals. As this market grows in size and variety of products, a clear definition of DTCT to ground the conceptualization of their harms and benefits is needed. We describe how three different modalities of DTCT (home self-testing, self-sampled tests, and direct access tests) present caveats to the traditional testing process ('brain-to-brain loop'), and how this might differ between medical vs. non-medical laboratories. We make recommendations for ways to improve quality and reduce errors with respect to DTCT. The potential benefits and harms of DTCT will invariably depend on the context and situation of individual consumers and the types of tests involved. Importantly, implications for both consumers and the healthcare system should be considered, such as the effects on improving health outcomes and reducing unnecessary testing and use of clinical resources. 'Consumer initiation' must be a central defining characteristic of DTCT, to clearly demarcate the key drawbacks as well as opportunities of this type of testing from a laboratory specialists' perspective. The concept of 'consumer initiated testing' should also help define DTCT regulation, and provide a locus of efforts to support consumers as the main decision-makers in the purchasing and conducting of these tests in the absence of clinician gatekeeping.
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Affiliation(s)
- Patti Shih
- Australian Centre for Health Engagement Evidence and Values, School of Health & Society, 8691 University of Wollongong , Wollongong, Australia
| | - Sverre Sandberg
- Noklus, Bergen, Norway
- Department of Public Global Health and Primary Care, University of Bergen, Bergen, Norway
- Noklus, The Norwegian Organization for Quality Improvement of Laboratory Examinations, Haraldsplass Diakonale Sykehus AS, Bergen, Norway
- Department of Public Global Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
| | - Jan Balla
- Klinicka biochemia a imunochemia, Analyticko-diagnosticke laboratorium, Kovacska, Presov, Slovakia
| | - Banu Isbilen Basok
- Faculty of Medicine, University of Health Sciences Izmir, Izmir, Türkiye
| | - Jennifer J Brady
- Department of Clinical Biochemistry, Children's Health Ireland at Temple St, Dublin 1, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Bernard Croal
- Aberdeen Royal Infirmary, NHS Grampian-Clinical Biochemistry, Aberdeen, Aberdeen, UK
| | - Nathalie De Vos
- LHUB-ULB Clinical Chemistry, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Mathias Karlsson
- Department of Medical Sciences, Section of Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Piret Kedars
- Central Laboratory, East Tallinn Central Hospital, Tallinn, Harjumaa, Estonia
| | - Tomris Ozben
- Department of Clinical Biochemistry, Medical Faculty, Akdeniz University, Antalya, Türkiye
- Faculty of Medicine and Surgery, Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Mario Plebani
- Dipartimento di Medicina di Laboratorio, Universita di Padova, Azienda Ospedaliera di Padova, Padova, Italy
| | - Matthias Orth
- Institut für Laboratoriumsmedizin, Vinzenz von Paul Kliniken gGmbH, Stuttgart, Baden-Württemberg, Germany
- Medical Faculty Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Germany
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Bignier C, Havet L, Brisoux M, Omeiche C, Misra S, Gonsard A, Drummond D. Climate change and children's respiratory health. Paediatr Respir Rev 2024:S1526-0542(24)00056-3. [PMID: 39107182 DOI: 10.1016/j.prrv.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 08/09/2024]
Abstract
Climate change has significant consequences for children's respiratory health. Rising temperatures and extreme weather events increase children's exposure to allergens, mould, and air pollutants. Children are particularly vulnerable to these airborne particles due to their higher ventilation per unit of body weight, more frequent mouth breathing, and outdoor activities. Children with asthma and cystic fibrosis are at particularly high risk, with increased risks of exacerbation, but the effects of climate change could also be observed in the general population, with a risk of impaired lung development and growth. Mitigation measures, including reducing greenhouse gas emissions by healthcare professionals and healthcare systems, and adaptation measures, such as limiting outdoor activities during pollution peaks, are essential to preserve children's respiratory health. The mobilisation of society as a whole, including paediatricians, is crucial to limit the impact of climate change on children's respiratory health.
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Affiliation(s)
| | | | | | | | | | - Apolline Gonsard
- Service de pneumologie et d'allergologie pédiatrique, hôpital universitaire Necker-Enfants-Malades, AP-HP, Paris, France
| | - David Drummond
- Université Paris Cité, Paris, France; Service de pneumologie et d'allergologie pédiatrique, hôpital universitaire Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Inserm UMR 1138, équipe HeKA, Centre de Recherche des Cordeliers, France.
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10
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Irwin A, Malik A, Vyas A, Bateman C, Joyce S. The carbon footprint of health care delivery in Western Australia's public health system. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 48:101115. [PMID: 39006230 PMCID: PMC11246056 DOI: 10.1016/j.lanwpc.2024.101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/06/2024] [Accepted: 05/27/2024] [Indexed: 07/16/2024]
Abstract
Background Health systems have a dual imperative to take action on climate change. First, they must develop climate resilient health services in response to the direct and indirect impacts of climate change on health. Second, they must reduce their own carbon footprint since health systems are a significant contributor to global greenhouse gas emissions. Methods An environmentally-extended multi-region input-output analysis was carried out, incorporating National Accounts data for Australia and annual expenditure data from WA Health for financial year 2019-20. Expenditure data were categorised to one of 344 economic sectors and by location of the provider of goods or services purchased. Findings WA Health contributes 8% of WA's total carbon footprint, driven by expenditure on chemicals (23.8% of total), transport (20.2% of total), and electricity supply (19.7% of total). These 3 sectors represent 63.7% of WA Health's carbon footprint, but only 10.8% of its total expenditure. Interpretation Reducing emissions related to health service provision in WA will require a holistic approach that leverages carbon footprinting insights and integrates them into organisational decision-making across all health programs. The high carbon-intensity of the transport and chemicals sectors supports previous research calling for a reduction in unnecessary pathology testing and the transition to delivery of non-urgent health care via sustainable models of telehealth. The impact of WA's size and location presents challenges, with a predominantly non-renewable energy supply and reliance on transport and supply chains from other states adding significantly to emissions. Funding The study received funding from the Australian Research Council, The University of Sydney, and the WA Department of Health. The full list of funding information can be found in Acknowledgements.
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Affiliation(s)
- Amanda Irwin
- The University of Sydney, ISA, School of Physics, Sydney, New South Wales, Australia
| | - Arunima Malik
- The University of Sydney, ISA, School of Physics, Sydney, New South Wales, Australia
- The University of Sydney, Discipline of Accounting, Sydney Business School, Sydney, New South Wales, Australia
- The University of Sydney, The University of Sydney Nano Institute, Faculty of Science, Sydney, New South Wales, Australia
| | - Aditya Vyas
- Healthy Environments and Lives (HEAL) Global Research Centre, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Catherine Bateman
- Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sarah Joyce
- Department of Health, Government of Western Australia, Perth, Western Australia, Australia
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11
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Lou A, Thoni A, Shandi N, Yang Z, Nassar BA, Elnenaei M. Effective stewardship strategies to enhance appropriateness of refer-out test requests in a Canadian tertiary centre laboratory. Clin Biochem 2024; 129:110777. [PMID: 38857837 DOI: 10.1016/j.clinbiochem.2024.110777] [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: 03/07/2024] [Revised: 05/17/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVES Specialized testing conducted in reference laboratories is costly and often not optimally directed. Since 2016, our institution has worked to ensure the appropriateness of refer-out (RO) tests. We examine the impact of utilization initiatives on the patterns of requests and completed tests. DESIGN AND METHODS In 2016, 81 RO tests were selected for a more rigorous approval process. Physicians not pre-approved for testing received a prompt to consult with laboratory subject matter experts (SMEs) for further detail. After review, SMEs provided responses, approving or rejecting requests based on clinical relevance. Stewardship activities also included: repatriating tests locally, preferring Canadian over foreign institutions, unbundling tests, distributing educational memos, and introducing staged testing. We collected data on the number of requested (NoR) and number of completed (NoC) tests in 2015, before the implementation of the new vetting procedures, and for the post-implementation phase from 2016-2022. RESULTS For 62 targeted RO tests (including trace metals, vitamins, antibodies, and endocrine-related tests), there was a 33% reduction in NoR and a 51% reduction in NoC in 2022 compared to 2015. The total savings for the study period based on NoC was $807,736. The NoC rate for Neuronal antibody tests decreased to 48.6% in 2022, with cost savings of $17,123, and an additional $50,000 saved by changing the testing site. Insourcing apolipoprotein B and fecal calprotectin tests resulted in cost savings of $3,380 and $3,371, respectively, in 2022. CONCLUSIONS Automated messaging followed by a formal review of RO test requests is an effective utilization strategy that prevents redundant or clinically unjustified testing. This approach leads to significant economic savings and is expected to improve the efficiency of patient care.
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Affiliation(s)
- Amy Lou
- Division of Clinical Chemistry, Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Andrea Thoni
- Division of Clinical Chemistry, Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nafisa Shandi
- Division of Clinical Chemistry, Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Zhifeng Yang
- Division of Clinical Chemistry, Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bassam A Nassar
- Division of Clinical Chemistry, Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Manal Elnenaei
- Division of Clinical Chemistry, Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
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12
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Pennestrì F, Tomaiuolo R, Banfi G, Dolci A. Blood over-testing: impact, ethical issues and mitigating actions. Clin Chem Lab Med 2024; 62:1283-1287. [PMID: 38156643 DOI: 10.1515/cclm-2023-1227] [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: 10/30/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
Plenty of studies demonstrate that hospital-acquired anemia (HAA) can increase transfusion rates, mortality, morbidity and cause unnecessary patient burden, including additional length of hospital stay, sleep disruption and venipuncture harms resulting from blood samples unlikely to change clinical management. Beyond patient costs, community costs should also be considered, such as laboratory time and resources waste, environmental impact, increasing pressure on labs and fewer tests available on time for patients who can benefit from them most. Blood over-testing does not support the principles of non-maleficence, justice and respect for patient autonomy, at the expense dubious beneficence. Reducing the number and frequency of orders is possible, to a certain extent, by adopting nudge strategies and raising awareness among prescribing doctors. However, reducing the orders may appear unsafe to doctors and patients. Therefore, reducing blood volume from each order is a better alternative, which is worth implementing through technological, purchasing and organizational arrangements, possibly combined according to need (smaller tubes, adequate analytic platforms, blind dilution, blood conservative devices, aggregating tests and laboratory units).
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Affiliation(s)
| | - Rossella Tomaiuolo
- IRCCS Istituto Ortopedico Galeazzi, Scientific Direction, Milan, Italy
- Vita-Salute San Raffaele University, School of Medicine, Milan, Italy
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Scientific Direction, Milan, Italy
- Vita-Salute San Raffaele University, School of Medicine, Milan, Italy
| | - Alberto Dolci
- SC Patologia Clinica, Dipartimento di Medicina di Laboratorio, Ospedale "Luigi Sacco", Milan, Italy
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi di Milano, Milan, Italy
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13
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Parker G, Hunter S, Born K, Miller FA. Mapping the Environmental Co-Benefits of Reducing Low-Value Care: A Scoping Review and Bibliometric Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:818. [PMID: 39063397 PMCID: PMC11276457 DOI: 10.3390/ijerph21070818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/07/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024]
Abstract
Reducing low-value care (LVC) and improving healthcare's climate readiness are critical factors for improving the sustainability of health systems. Care practices that have been deemed low or no-value generate carbon emissions, waste and pollution without improving patient or population health. There is nascent, but growing, research and evaluation to inform practice change focused on the environmental co-benefits of reducing LVC. The objective of this study was to develop foundational knowledge of this field through a scoping review and bibliometric analysis. We searched four databases, Medline, Embase, Scopus and CINAHL, and followed established scoping review and bibliometric analysis methodology to collect and analyze the data. A total of 145 publications met the inclusion criteria and were published between 2013 and July 2023, with over 80% published since 2020. Empirical studies comprised 21%, while commentary or opinions comprised 51% of publications. The majority focused on healthcare generally (27%), laboratory testing (14%), and medications (14%). Empirical publications covered a broad range of environmental issues with general and practice-specific 'Greenhouse gas (GHG) emissions', 'waste management' and 'resource use' as most common topics. Reducing practice-specific 'GHG emissions' was the most commonly reported environmental outcome. The bibliometric analysis revealed nine international collaboration networks producing work on eight key healthcare areas. The nineteen 'top' authors were primarily from the US, Australia and Canada.
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Affiliation(s)
| | | | | | - Fiona A. Miller
- Collaborative Centre for Climate, Health & Sustainable Care, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
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14
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Soong JL, Ho PL, Neo VSH, Lie SA. Evaluating the carbon footprint of sedation practices in intensive care. Nurs Crit Care 2024. [PMID: 38866584 DOI: 10.1111/nicc.13092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/24/2023] [Accepted: 05/13/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Healthcare's carbon footprint contributes to 4.4% of global net emissions and intensive care units (ICUs) are very resource intensive. Existing studies on environmental sustainability in ICUs focused on carbon footprint generated from energy and electricity consumption, use of medical consumables and equipment, but few studies quantified carbon footprint generated from pharmaceuticals used in ICUs. AIM To evaluate carbon footprint arising from sedation practices in the ICUs. STUDY DESIGN A pilot, prospective observational study was conducted in two ICUs from 1 August to 22 September 2022 in Singapore General Hospital. Adult patients who were consecutively sedated, intubated and expected to be mechanically ventilated for at least 24 h were included. Total amount of analgesia and sedatives used and wasted in eligible patients were collected. Carbon emission from ICU sedation practices were then quantified using available life cycle assessment data. RESULTS A total of 31 patients were recruited. Top analgesia and sedative used in both ICUs were fentanyl and propofol, respectively. Carbon footprint from sedative usage and wastage across 7 weeks in both ICUs were 2.206 kg CO2-e and 0.286 g CO2-e, respectively. In total, this equates to driving 15.8 km by car. Proportion of drug wasted ranged from 5.1% to 25.0%, with the top reason for wastage being the drug was no longer clinically indicated. Recommendations to reduce carbon footprint include choosing sedatives with lower carbon emissions where possible and having effective communication among doctors and nurses regarding management plans to minimize unnecessary wastage. CONCLUSION Our study quantified carbon footprint arising from sedation practices, mainly drug usage and wastage in two ICUs in Singpore General Hospital. RELEVANCE TO CLINICAL PRACTICE Adopting a holistic approach to environmental sustainability in the ICU, sedation practices also contribute to generating greenhouse gases, albeit small, and can be targeted to reduce unnecessary carbon footprint.
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Affiliation(s)
- Jie Lin Soong
- Division of Pharmacy, Singapore General Hospital, Singapore, Singapore
- Department of Pharmacy and Pharmaceutical Sciences, National University of Singapore, Singapore, Singapore
| | - Pei Lin Ho
- Division of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | | | - Sui An Lie
- Department of Surgical Intensive Care, Singapore General Hospital, Singapore, Singapore
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15
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Williams JTW, Bell KJL, Morton RL, Dieng M. Methods to Include Environmental Impacts in Health Economic Evaluations and Health Technology Assessments: A Scoping Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:794-804. [PMID: 38462223 DOI: 10.1016/j.jval.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 02/14/2024] [Accepted: 02/29/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVES The environmental impacts of healthcare are important factors that should be considered during health technology assessments. This study aims to summarize the evidence that exists about methods to include environmental impacts in health economic evaluations and health technology assessments. METHODS We identified records for screening using an existing scoping review and a systematic search of academic databases and gray literature up to September 2023. We screened the identified records for eligibility and extracted data using a narrative synthesis approach. The review was conducted following the JBI Manual for Evidence Synthesis and reported according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses Extension for Scoping Reviews checklist. RESULTS We identified 2898 records and assessed the full text of 114, of which 54 were included in this review. Ten methods were identified to include environmental impacts in health economic evaluations and health technology assessments. Methods included converting environmental impacts to dollars or disability-adjusted life years and including them in a cost-effectiveness, cost-utility, or cost-benefit analysis, calculating an incremental carbon footprint effectiveness ratio or incremental carbon footprint cost ratio, incorporating impacts as one criteria of a multi-criteria decision analysis, and freely considering impacts during health technology assessment deliberation processes. CONCLUSIONS Methods to include environmental impacts in health economic evaluations and health technology assessments exist but have not been tested for widespread use by health technology assessment agencies. Further research and implementation work is needed to determine which method can best aid decision makers to choose low environmental impact healthcare interventions.
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Affiliation(s)
- Jake T W Williams
- Faculty of Medicine and Health, School of Public Health, Sydney, New South Wales, Australia.
| | - Katy J L Bell
- Faculty of Medicine and Health, School of Public Health, Sydney, New South Wales, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Mbathio Dieng
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
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16
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McAlister S, Luyckx VA, Viecelli AK. Cutting back on low-value health care practices supports sustainable kidney care. Kidney Int 2024; 105:1178-1185. [PMID: 38513999 DOI: 10.1016/j.kint.2023.12.022] [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: 09/24/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 03/23/2024]
Abstract
July 2023 marked the hottest month on record, underscoring the urgent need for action on climate change. The imperative to reduce carbon emissions extends to all sectors, including health care, with it being responsible for 5.5% of global emissions. In decarbonizing health care, although much attention has focused on greening health care infrastructure and procurement, less attention has focused on reducing emissions through demand-side management. An important key element of this is reducing low-value care, given that ≈20% of global health care expenditure is considered low value. "Value" in health care, however, is subjective and dependent on how health outcomes are regarded. This review, therefore, examines the 3 main value perspectives specific to health care. Clinical effectiveness defines low-value care as interventions that offer little to no benefit or have a risk of harm exceeding benefits. Cost-effectiveness compares health outcomes versus costs compared with an alternative treatment. In this case, low-value care is care greater than a societal willingness to pay for an additional unit of health (quality-adjusted life year). Last, community perspectives emphasize the value of shared decision-making and patient-centered care. These values sit within broader societal values of ethics and equity. Any reduction in low-value care should, therefore, also consider patient autonomy, societal value perspectives and opportunity costs, and equity. Deimplementing entrenched low-value care practices without unnecessarily compromising ethics and equity will require tailored strategies, education, and transparency.
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Affiliation(s)
- Scott McAlister
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Andrea K Viecelli
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Australasian Kidney Trials Network, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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17
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Vergara R, Chouvel R, Vergier B, Le Bail B, Négrier-Leibreich ML, Belleannée G, Rullier A, Marty M. Reducing reflex first-line prescriptions in a surgical pathology laboratory: toward sustainable practice with positive economic and clinical effects. Virchows Arch 2024:10.1007/s00428-024-03817-5. [PMID: 38730093 DOI: 10.1007/s00428-024-03817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/22/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024]
Abstract
In surgical pathology departments, reflex first-line techniques (RFLTs) are aimed at reducing workloads and addressing recent shortages of medical personnel. However, the impacts thereof on economic and diagnostic factors have been poorly addressed. Also, in the era of global warming, environmental considerations are crucial. This study assessed the economic and diagnostic efficacies of routine pathological RFLT and the quality of care and sustainability. Ten RFLTs of the Bordeaux University Hospital pathology department (six special stains, one cytology technique, and three immunohistochemical tests) were studied. First, a retrospective economic analysis evaluated the average cost of these RFLTs per slide and per year. Second, diagnostic relevance was prospectively surveyed. Third, the effects of changes made were analyzed over 2 years. The ten RFLTs were associated with average annual costs of €46,708. Diagnostic relevance analysis indicated that most stains were unnecessary; only 17% were requested as second-line techniques. Elimination of 7/10 tests afforded annual cost savings of €22,522 and reduced the workload by 5568 tests/year, without compromising the workflow or diagnostic quality. Seven of ten RFLTs could be eliminated without compromising diagnostic quality or the workflow. This afforded not only financial benefits but also positive social and environmental impacts. We offer valuable insights into appropriate practices in surgical pathology laboratories. Collaboration between the medical and technical teams was crucial; other healthcare sectors would also benefit from our approach.
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Affiliation(s)
- Rémi Vergara
- Pathology Department, Bordeaux University Hospital, Bordeaux, France.
| | - Rudy Chouvel
- Fédération Hospitalière de France, Paris, France
| | - Béatrice Vergier
- Pathology Department, Bordeaux University Hospital, Bordeaux, France
- BoRdeaux Institute of onCology (BRIC)-UMR 1312 INSERM University of Bordeaux, Bordeaux, France
| | - Brigitte Le Bail
- Pathology Department, Bordeaux University Hospital, Bordeaux, France
- BoRdeaux Institute of onCology (BRIC)-UMR 1312 INSERM University of Bordeaux, Bordeaux, France
| | | | | | - Anne Rullier
- Pathology Department, Bordeaux University Hospital, Bordeaux, France
| | - Marion Marty
- Pathology Department, Bordeaux University Hospital, Bordeaux, France
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18
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Gaetani M, Uleryk E, Halgren C, Maratta C. The carbon footprint of critical care: a systematic review. Intensive Care Med 2024; 50:731-745. [PMID: 38416200 DOI: 10.1007/s00134-023-07307-1] [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: 08/07/2023] [Accepted: 12/11/2023] [Indexed: 02/29/2024]
Abstract
PURPOSE The provision of healthcare is a substantial global contributor to greenhouse gas (GHG) emissions. Several medical specialties and national health systems have begun evaluating their carbon emission contributions. The aim of this review is to summarise and describe the carbon footprint resulting from the provision of adult, paediatric and neonatal critical care. METHODS A systematic search of Embase, Cochrane and Web of Science was performed in January 2023. Studies reporting any assessment of the carbon footprint of critical care were included. No language restrictions were applied. GHG emissions from life cycle assessments (LCA) were reported, in addition to waste, electricity and water use. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed. RESULTS In total, 13 studies assessing and describing the environmental impact of 36 adult or paediatric intensive care units (ICUs) were included. Two studies described full LCAs, seven reported waste only, two provided audits of unused medical supplies, one reported electricity use, and one study described a Material Flow Analysis. The estimated carbon emissions from critical care range between 88 kg CO2e/patient/day and 178 kg CO2e/patient/day. The two predominant sources of carbon emissions in critical care originate from electricity and gas use, as well as consumables. Waste production ranged from 1.1 to 13.7 kg/patient/day in the 6 studies where mean waste could be calculated. CONCLUSION There is a significant carbon footprint that results from intensive care provision. Consumables and waste constitute important, measurable, and modifiable components of anthropogenic emissions. There remains uncertainty due to a lack of literature, several unstudied areas of carbon emissions from critical care units, and within measured areas, measurement and reporting of carbon emissions are inconsistent.
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Affiliation(s)
- Melany Gaetani
- Department of Critical Care, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Camilla Halgren
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Christina Maratta
- Department of Critical Care, Hospital for Sick Children, Toronto, Ontario, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
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19
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Raurell-Torredà M, Fernández-Castillo RJ, Rodríguez-Delgado ME, Arias-Rivera S, Basco-Prado L. Best practices for iatrogenic anaemia prevention in the intensive care unit: Blood-sparing techniques. Nurs Crit Care 2024. [PMID: 38654607 DOI: 10.1111/nicc.13084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/30/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
Anaemia is a common issue in patients who are admitted to intensive care units and worsens their condition throughout the stay due to the extraction of blood for diagnostic purposes. It is also well-known that an important amount of the carbon dioxide produced by health services is likely attributable to blood donation, testing and manufacture, storage or distribution of blood components. This must be taken into account to perform nursing interventions consistent with the idea of sustainable health care. In this regard, within patient blood management bundles, with the objective of minimizing the use of blood products, it is recommended to use blood-sparing techniques: small volume tubes (SVT) or closed-blood sampling devices (CBSD). Published studies before 2014 (excepting two more recent ones) have shown that by themselves, both techniques reduce drawn volume but do not decrease haemoglobin reduction and/or need of transfusion. Given the lack of cost-effectiveness studies, it may be easier to implement the use of CBSD as it does not require prior consensus on the discard volume or adaptations in the processing of laboratory tests, as is the case with SVT.
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Affiliation(s)
- Marta Raurell-Torredà
- Departament d'Infermeria Fonamental i Clínica, Universitat de Barcelona, Barcelona, Spain
| | - Rafael-Jesús Fernández-Castillo
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
- Intensive Care Clinical Unit, University Hospital Virgen Macarena, Seville, Spain
| | | | | | - Luis Basco-Prado
- Departament d'Infermeria Fonamental i Clínica, Universitat de Barcelona, Barcelona, Spain
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20
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Hibbs SP, Thomas S, Agarwal N, Andrews C, Eskander S, Abdalla AS, Staves J, Eckelman MJ, Murphy MF. What is the environmental impact of a blood transfusion? A life cycle assessment of transfusion services across England. Transfusion 2024; 64:638-645. [PMID: 38506497 DOI: 10.1111/trf.17786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/02/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Healthcare activities significantly contribute to greenhouse gas (GHG) emissions. Blood transfusions require complex, interlinked processes to collect, manufacture, and supply. Their contribution to healthcare emissions and avenues for mitigation is unknown. STUDY DESIGN AND METHODS We performed a life cycle assessment (LCA) for red blood cell (RBC) transfusions across England where 1.36 million units are transfused annually. We defined the process flow with seven categories: donation, transportation, manufacturing, testing, stockholding, hospital transfusion, and disposal. We used direct measurements, manufacturer data, bioengineering databases, and surveys to assess electrical power usage, embodied carbon in disposable materials and reagents, and direct emissions through transportation, refrigerant leakage, and disposal. RESULTS The central estimate of carbon footprint per unit of RBC transfused was 7.56 kg CO2 equivalent (CO2eq). The largest contribution was from transportation (2.8 kg CO2eq, 36% of total). The second largest was from hospital transfusion processes (1.9 kg CO2eq, 26%), driven mostly by refrigeration. The third largest was donation (1.3 kg CO2eq, 17%) due to the plastic blood packs. Total emissions from RBC transfusion are ~10.3 million kg CO2eq/year. DISCUSSION This is the first study to estimate GHG emissions attributable to RBC transfusion, quantifying the contributions of each stage of the process. Primary areas for mitigation may include electric vehicles for the blood service fleet, improving the energy efficiency of refrigeration, using renewable sources of electricity, changing the plastic of blood packs, and using methods of disposal other than incineration.
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Affiliation(s)
- Stephen P Hibbs
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Nikhil Agarwal
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Charlotte Andrews
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Sylvia Eskander
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, USA
| | | | - Julie Staves
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Matthew J Eckelman
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Michael F Murphy
- NHS Blood and Transplant, London, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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21
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Graham M, Gugasyan R, Dharmaraj D, Yap G, Webb B, Dhulia A, Kumar B. Impact of customized electronic duplicate order alerts on microbiology test ordering: Financial and environmental cost savings. Infect Control Hosp Epidemiol 2024; 45:343-350. [PMID: 37887261 PMCID: PMC10933501 DOI: 10.1017/ice.2023.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/10/2023] [Accepted: 07/26/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE To estimate cost savings after implementation of customized electronic duplicate order alerts. DESIGN Alerts were implemented for microbiology tests at the largest public hospital in Victoria, Australia. These alerts were designed to pop up at the point of test ordering to inform the clinician that the test had previously been ordered and to suggest appropriate reordering time frames and indications. RESULTS In a 6-month audit of urine culture (our most commonly ordered test) after alert implementation, 2,904 duplicate requesters proceeded with the request and 2,549 tests were cancelled, for a 47% reduction in test ordering. For fecal polymerase chain reaction (PCR), our second most common test, there was a 54% reduction in test ordering. For our most commonly ordered expensive test, hepatitis C PCR, there was a 42% reduction in test ordering: 25 tests were cancelled.Cancelled tests resulted in estimated savings of AU$52,382 (US$33,960) for urine culture, AU$34,914 (US$22,442) for fecal PCR, AU$4,506 (US$2,896) for hepatitis C PCR. For cancelled hepatitis B PCR and Epstein-Barr virus (EBV) and cytomegalovirus (CMV) serology, the cost savings was AU$8,472 (US$5445). The estimated financial cost saving in direct hospital costs for these 6 assays was AU$100,274 (US$67,925) over the 6-month period. Environmental waste cost saving by weight was estimated to be 280 kg. Greenhouse gas footprint, measured in carbon dioxide equivalent emissions for cancelled EBV and CMV serology tests, resulted in a saving of at least 17,711 g, equivalent to driving 115 km in a standard car. CONCLUSION Customized alerts issued at the time of test ordering can have enormous impacts on reducing cost, waste, and unnecessary testing.
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Affiliation(s)
- Maryza Graham
- Department of Microbiology, Monash Health Pathology, Monash Health, Clayton, Victoria, Australia
- Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity, Victoria, Australia
| | - Robert Gugasyan
- Monash Health Pathology, Monash Health, Clayton, Victoria, Australia
| | - Devisri Dharmaraj
- Office of Chief Medical Officer, Monash Health, Clayton, Victoria, Australia
| | - Gillian Yap
- Office of Chief Medical Officer, Monash Health, Clayton, Victoria, Australia
| | - Brooke Webb
- Department of Microbiology, Monash Health Pathology, Monash Health, Clayton, Victoria, Australia
| | - Anjali Dhulia
- Chief Medical Officer, Monash Health, Clayton, Victoria, Australia
| | - Beena Kumar
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
- Monash Health Pathology, Monash Health, Clayton, Victoria, Australia
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22
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Ostermann M, De Waele JJ, Schefold JC. The environmental impact of laboratory measurements in high-resource ICUs. Intensive Care Med 2024; 50:449-452. [PMID: 38353712 DOI: 10.1007/s00134-023-07318-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/29/2023] [Indexed: 03/21/2024]
Affiliation(s)
- Marlies Ostermann
- Department of Intensive Care, King's College London, Guy's & St Thomas' Hospital, London, UK.
| | - Jan J De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, University of Bern, Bern, Switzerland
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23
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Austin J, Fields L, Ridla AZ, Alexandrou E, Ferguson C. Twelve actions in healthcare to reduce carbon emissions. Eur J Cardiovasc Nurs 2024; 23:e6-e8. [PMID: 37534764 DOI: 10.1093/eurjcn/zvad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Jessie Austin
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Lorraine Fields
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Akhmad Zainur Ridla
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
- Faculty of Nursing, University of Jember, East Java, Indonesia
| | - Evan Alexandrou
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Caleb Ferguson
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
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24
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Fogarty AE, Wilson A, Godambe M, Shinde N, Gou C, Decker G, Steensma J. The carbon footprint of epidural steroid injections: A pilot study. PM R 2023. [PMID: 38037489 DOI: 10.1002/pmrj.13111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/22/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Epidural steroid injections are common procedures in physical medicine and rehabilitation practice. However, their environmental impact has not been characterized. OBJECTIVE The primary aim is to estimate and compare the carbon footprint of two standard injection kits used to perform epidural steroid injections at a single academic institution. Secondary objectives were (1) to create a step-by-step guide for estimating the carbon footprint of materials and (2) to survey physicians on practice patterns and identify areas for improvement. DESIGN Pilot study. SETTING Academic medical center. PARTICIPANTS N/A. INTERVENTIONS N/A. OUTCOME MEASURES Carbon emissions measured in CO2 equivalents (CO2 eq). METHODS Using guidance from the Greenhouse Gas Protocol, the carbon footprint of the two kits was estimated by taking the sum of carbon emissions resulting from the production of the kit materials and the carbon emissions resulting from the waste disposal of the kit materials. RESULTS The carbon footprint of the transforaminal epidural steroid injection (TFESI) kit was estimated at 1.328 kg CO2 eq. The carbon footprint of the interlaminar epidural steroid injection (ILESI) kit was estimated at 2.534 kg CO2 eq. For both kits, the carbon emissions resulting from the production of the kits were greater than the emissions resulting from disposal. The survey of interventionalists performing TFESI revealed all respondents required materials in addition to those provided in the standard epidural kit. Despite this, kit materials were typically wasted in 62% of respondents. CONCLUSION Creating a methodology for quantifying carbon emissions is the first step to reducing carbon emissions. Once emissions are measured, the health care industry can determine the most effective strategies for reducing its impact. Our analysis has shown that it is feasible to perform emissions calculations and delineates a clear method with publicly available resources. Solutions to reduce epidural injection carbon footprint waste may include improved kit customization.
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Affiliation(s)
- Alexandra E Fogarty
- Department of Orthopaedic Surgery, Division of Physical Medicine & Rehabilitation, Washington University School of Medicine, Campus Box 8233, Saint Louis, Missouri, USA
| | - Annalee Wilson
- Brown School, Washington University in St. Louis, One Booking Drive, Campus Box 1196, St. Louis, Missouri, USA
| | - Maya Godambe
- Brown School, Washington University in St. Louis, One Booking Drive, Campus Box 1196, St. Louis, Missouri, USA
| | - Nidhi Shinde
- Brown School, Washington University in St. Louis, One Booking Drive, Campus Box 1196, St. Louis, Missouri, USA
| | - Christine Gou
- Department of Orthopaedic Surgery, Division of Physical Medicine & Rehabilitation, Washington University School of Medicine, Campus Box 8233, Saint Louis, Missouri, USA
| | - Gregory Decker
- Department of Orthopaedic Surgery, Division of Physical Medicine & Rehabilitation, Washington University School of Medicine, Campus Box 8233, Saint Louis, Missouri, USA
| | - Joe Steensma
- Brown School, Washington University in St. Louis, One Booking Drive, Campus Box 1196, St. Louis, Missouri, USA
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van Ee EPJXW, Barker NDJ, Barker JH. ER24/1 !: The greatest emergency of our time. Eur J Trauma Emerg Surg 2023; 49:2323-2325. [PMID: 37367971 PMCID: PMC10728227 DOI: 10.1007/s00068-023-02314-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
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Fan BE, Tan JG, Favaloro EJ. Reducing our carbon footprint in the haematology laboratory: A shared responsibility. Int J Lab Hematol 2023; 45:778-780. [PMID: 36967596 DOI: 10.1111/ijlh.14060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/05/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Bingwen Eugene Fan
- Department of Haematology, Tan Tock Seng Hospital, Singapore
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jun Guan Tan
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore
| | - Emmanuel J Favaloro
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Sydney Centres for Thrombosis and Haemostasis, NSW Health Pathology, Westmead Hospital, Westmead, Australia
- School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, Australia
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
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Sowa PM, Fooken J, McGowan K, Birch S. Disposable and reusable instruments in dental health practice: A comparison of cost factors in a public provider organization in Queensland, Australia. Community Dent Oral Epidemiol 2023; 51:794-803. [PMID: 35661220 DOI: 10.1111/cdoe.12764] [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: 11/25/2021] [Revised: 03/12/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Choosing between reusable instruments (RIs) and disposable instruments (DIs) for dental care provision requires a careful consideration of costs and their contributing factors, alongside other choice criteria. This study aimed to assess the current use of instruments in the West Moreton Oral Health Service (WMOHS) in Queensland, Australia, with a broader goal of informing future practice in this and comparable organizations. METHODS A cost model was developed reflecting costs arising from procurement, reprocessing and disposal, depending on the RI and DI composition of instrumentation. The current practice in WMOHS was compared to modular (RI-only and DI-only) strategies by considering four standard instrument sets (examination, simple extraction, surgical extraction, restoration) and the annual use of instruments in the organization at large. The use of resources (water, electricity) and emissions (waste) were quantified for each strategy. The robustness of findings was explored across a range of scenarios that involved varying instrument prices, lifespans, factors impacting on the cost of reprocessing (labour, water, energy), the cost of waste disposal and couriering. RESULTS At the organization level, the current mix of instruments (A$1.28 m per year) was 4% more costly than the lower cost, RI-only alternative (A$1.23 m). However, with lower DI prices or higher labour costs current practice would become the lowest cost option. Results for specific instrument sets varied by service type. DI-only offered the lowest cost option for oral examinations (A$6.29), and the current practice of mixed instrumentation for simple extractions (A$16.56). RI-only sets were less costly in more resource intensive procedures such as surgical extractions (A$40.19) and restorations (A$43.83). In terms of environmental impacts, the use of instruments based on current practice required 37% of water and energy use of an RI-only alternative and generated 36% waste of the DI-only alternative. CONCLUSIONS Reusable instruments are generally less costly than DIs, but for specific instrument sets the outcome depends on the type of procedure. In some circumstances, mixed instrumentation can provide the lowest cost alternative. While the WMOHS instrument mix used in current practice does not minimize cost for the provider, it may be justified in light of operational risks, logistics and uncertainty regarding cost factors.
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Affiliation(s)
- P Marcin Sowa
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Jonas Fooken
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Kelly McGowan
- Oral Health Service, West Moreton Health, Ipswich, Queensland, Australia
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - Stephen Birch
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, Queensland, Australia
- Centre for Health Economics, The University of Manchester, Manchester, UK
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Salazar Moya J, Rojas-Zumaran V, Vegas C, Salafia A, Contreras-Pulache H. Use of grape-based stain (Vinatela) on cervical cytology: A Peruvian validation study. Cytojournal 2023; 20:30. [PMID: 37810437 PMCID: PMC10559590 DOI: 10.25259/cytojournal_19_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/10/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives The Papanicolaou's (Pap's) stain is used for cervical cancer screening. It employs toxic-carcinogenic expensive reagents, which may not be easily accessible to many communities worldwide. The objective of this study was to validate the grape-based alcohol-extracted dye (Vinatela) on normal cervical samples for the Pap test. Material and Methods Samples of the two grape species were collected from two vineyards through the Agroindustrial Research Institute of Universidad Privada San Juan Bautista. The dye extraction from the grape species and the dye performance to stain cells were conducted in three phases: (a) direct staining with pre-fermentation wine products, (b) direct fragmentation of grapes and direct staining with shells of the grapes, and (c) alcoholic extraction of the dye. Vinatela obtained from two species (Vitis vinifera "Tempranillo" and "Malbec") and posterior staining of cervical samples. We conducted a double-blind validation on 30 cervical samples. Results The basophilic components of the cervical cells were stained. Alcoholic extraction staining protocol had a low yield. The nuclear and cytoplasmic borders, the nuclear details, and the polymorphonuclear nuclei were stained with Vinatela and could be differentiated during nuclear coloration. The initial staining protocol was 10- 20 min × (mean ~12 min) staining time. We noted a slightly better staining with V. v. Tempranillo as compared to V. v. Malbec (P = 0.045). Conclusion Cervical cells stained with Vinatela stain from two grape species cultivated in the Southern of Peru, showed basophilic nuclear details.
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Affiliation(s)
- Jeel Salazar Moya
- Graduate School, Universidad Privada San Juan Bautista, Peru
- Department of Biomedical Engineering, Faculty of Engineering, Universidad Tecnológica del Perú, Lima, Peru
| | - Victor Rojas-Zumaran
- Department of Pathology, Hospital Nacional Docente Madre-Niño San Bartolomé, Lima, Peru
- School of Engineering in Enology and Viticulture, Universidad Privada San Juan Bautista, Ica, Perú
| | - Carlos Vegas
- School of Engineering in Enology and Viticulture, Universidad Privada San Juan Bautista, Ica, Perú
| | - Amalia Salafia
- School of Engineering in Enology and Viticulture, Universidad Privada San Juan Bautista, Ica, Perú
- Faculty of Oenology and Agroindustries, Universidad Maza, Mendoza, Argentina, Peru
| | - Hans Contreras-Pulache
- South America Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, Peru
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Glover RT, Booth GS, Wiencek JR. Opportunities for recycling in an automated clinical chemistry laboratory produced by the comprehensive metabolic panel. Am J Clin Pathol 2023; 160:119-123. [PMID: 37029539 DOI: 10.1093/ajcp/aqad031] [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: 01/17/2023] [Accepted: 02/27/2023] [Indexed: 04/09/2023] Open
Abstract
OBJECTIVES Clinical laboratories perform a variety of tests for which biomedical waste is a byproduct. Of these, the complete metabolic panel (CMP) produces a significant portion of this waste. We investigated specific waste subsequent to performing CMPs over the course of a year and analyzed what percentage of the waste produced could have been recycled. METHODS Patient testing volumes were collected retrospectively from July 14, 2021, to July 14, 2022, for individual assays within the CMP performed on Abbott Alinity c instruments (n = 6). The average weights for components of the reagent kits, which includes wedges, boxes, and package inserts, were calculated. These weights, in conjunction with total patient testing volumes, were used to determine the amount of waste produced. RESULTS A total of 1089.2 kg of reagent kit waste was estimated to be produced by performing CMPs throughout a year. Of this waste, most (855.5 kg) was not recyclable, but a subset (233.6 kg) was. Overall, 21.4% of the total specific waste weight was found to be recyclable. CONCLUSIONS The CMP contributes a substantial amount of waste when performed on chemistry analyzer platforms in the clinical laboratory. Paper inserts and cardboard packaging, however, presented opportunities for recycling.
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Affiliation(s)
- Raeshun T Glover
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, US
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, US
| | - Joesph R Wiencek
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, US
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Wood NAE, Farmer L, Croker R, Kyle S, Lewis T. Saving the planet with reduced routine DMARD blood monitoring frequency. BMJ 2023; 382:p1645. [PMID: 37463694 DOI: 10.1136/bmj.p1645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Natasha A E Wood
- Rheumatology Department, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Leila Farmer
- Rheumatology Department, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | | | - Stuart Kyle
- Rheumatology Department, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Tom Lewis
- Rheumatology Department, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
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Spoyalo K, Lalande A, Rizan C, Park S, Simons J, Dawe P, Brown CJ, Lillywhite R, MacNeill AJ. Patient, hospital and environmental costs of unnecessary bloodwork: capturing the triple bottom line of inappropriate care in general surgery patients. BMJ Open Qual 2023; 12:e002316. [PMID: 37402596 DOI: 10.1136/bmjoq-2023-002316] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/26/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE To characterise the extent of unnecessary care in general surgery inpatients using a triple bottom line approach. DESIGN Patients with uncomplicated acute surgical conditions were retrospectively evaluated for unnecessary bloodwork according to the triple bottom line, quantifying the impacts on patients, healthcare costs and greenhouse gas emissions. The carbon footprint of common laboratory investigations was estimated using PAS2050 methodology, including emissions generated from the production, transport, processing and disposal of consumable goods and reagents. SETTING Single-centre tertiary care hospital. PARTICIPANTS Patients admitted with acute uncomplicated appendicitis, cholecystitis, choledocholithiasis, gallstone pancreatitis and adhesive small bowel obstruction were included in the study. 304 patients met inclusion criteria and 83 were randomly selected for in-depth chart review. MAIN OUTCOME MEASURES In each patient population, the extent of over-investigation was determined by comparing ordered laboratory investigations against previously developed consensus recommendations. The quantity of unnecessary bloodwork was measured by number of phlebotomies, tests and blood volume in addition to healthcare costs and greenhouse gas emissions. RESULTS 76% (63/83) of evaluated patients underwent unnecessary bloodwork resulting in a mean of 1.84 phlebotomies, 4.4 blood vials, 16.5 tests and 18 mL of blood loss per patient. The hospital and environmental cost of these unnecessary activities was $C5235 and 61 kg CO2e (974 g CO2e per person), respectively. The carbon footprint of a common set of investigations (complete blood count, differential, creatinine, urea, sodium, potassium) was 332 g CO2e. Adding a liver panel (liver enzymes, bilirubin, albumin, international normalised ratio/partial thromboplastin time) resulted in an additional 462 g CO2e. CONCLUSIONS We found considerable overuse of laboratory investigations among general surgery patients admitted with uncomplicated acute surgical conditions resulting in unnecessary burden to patients, hospitals and the environment. This study identifies an opportunity for resource stewardship and exemplifies a comprehensive approach to quality improvement.
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Affiliation(s)
- Karina Spoyalo
- Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Annie Lalande
- Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Chantelle Rizan
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Sophia Park
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Janet Simons
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Philip Dawe
- Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Carl J Brown
- Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Lillywhite
- School of Life Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrea J MacNeill
- Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
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Duan X, Shao W, Jiang W, Tan X, Zhu J, Yang J, Zhao Y, Zhang C, Yu Q, Yang Y, Zhou J, Pan B, Wang B, Guo W. Status of phlebotomy tube utilization at a major medical center. Are we using too many phlebotomy tubes? Heliyon 2023; 9:e15334. [PMID: 37131426 PMCID: PMC10149253 DOI: 10.1016/j.heliyon.2023.e15334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 05/04/2023] Open
Abstract
Background and objectives Overutilization of phlebotomy tubes at healthcare facilities leads to iatrogenic anemia, patient dissatisfaction, and increase in operational costs. In this study, we analyzed the phlebotomy tube usage data at the Zhongshan Hospital, Fudan University, to show potential inefficiencies with phlebotomy tube usage. Methods Data of 984,078 patients with 1,408,175 orders and 4,622,349 total phlebotomy tubes were collected during years 2018-2021. Data of different patient types were compared. Furthermore, we assessed the data from subspecialty and test levels to explore the factors influencing the increase in phlebotomy tube usage. Results We observed an overall 8% increase in both the mean number of tubes used and blood loss per order over the past 4 years. The mean blood loss per day for intensive care unit (ICU) patients was 18.7 ml (maximum 121.6 ml), which was well under the 200 ml/day threshold. However, the maximum number of tubes used reached more than 30 tubes/day. Conclusions The 8% increase of phlebotomy tubes over 4 years should alarm laboratory managements, as tests offered are expected to increase in the future. Importantly, the whole healthcare community needs to work together to solve this problem with more creative solutions.
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Affiliation(s)
- Xincen Duan
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenqi Shao
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenhai Jiang
- IT Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao Tan
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Zhu
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Yang
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yin Zhao
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunyan Zhang
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qian Yu
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yihui Yang
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiaye Zhou
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Baishen Pan
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Corresponding author. Clinical Laboratory Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China.
| | - Beili Wang
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Corresponding authors. Clinical Laboratory Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China.
| | - Wei Guo
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Corresponding author. Clinical Laboratory Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China.
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Batcup C, Breth-Petersen M, Dakin T, Barratt A, McGain F, Newell BR, Pickles K. Behavioural change interventions encouraging clinicians to reduce carbon emissions in clinical activity: a systematic review. BMC Health Serv Res 2023; 23:384. [PMID: 37081553 PMCID: PMC10116654 DOI: 10.1186/s12913-023-09370-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/04/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Clinical activity accounts for 70-80% of the carbon footprint of healthcare. A critical component of reducing emissions is shifting clinical behaviour towards reducing, avoiding, or replacing carbon-intensive healthcare. The objective of this systematic review was to find, map and assess behaviour change interventions that have been implemented in healthcare settings to encourage clinicians to reduce greenhouse gas emissions from their clinical activity. METHODS Studies eligible for inclusion were those reporting on a behaviour change intervention to reduce carbon emissions via changes in healthcare workplace behaviour. Six databases were searched in November 2021 (updated February 2022). A pre-determined template was used to extract data from the studies, and risk of bias was assessed. The behaviour change techniques (BCTs) used in the interventions were coded using the BCT Taxonomy. RESULTS Six full-text studies were included in this review, and 14 conference abstracts. All studies used a before-after intervention design. The majority were UK studies (n = 15), followed by US (n = 3) and Australia (n = 2). Of the full-text studies, four focused on reducing the emissions associated with anaesthesia, and two aimed at reducing unnecessary test ordering. Of the conference abstracts, 13 focused on anaesthetic gas usage, and one on respiratory inhalers. The most common BCTs used were social support, salience of consequences, restructuring the physical environment, prompts and cues, feedback on outcome of behaviour, and information about environmental consequences. All studies reported success of their interventions in reducing carbon emissions, prescribing, ordering, and financial costs; however, only two studies reported the magnitude and significance of their intervention's success. All studies scored at least one item as unclear or at risk of bias. CONCLUSION Most interventions to date have targeted anaesthesia or pathology test ordering in hospital settings. Due to the diverse study outcomes and consequent inability to pool the results, this review is descriptive only, limiting our ability to conclude the effectiveness of interventions. Multiple BCTs were used in each study but these were not compared, evaluated, or used systematically. All studies lacked rigour in study design and measurement of outcomes. REVIEW REGISTRATION The study was registered on Prospero (ID number CRD42021272526) (Breth-Petersen et al., Prospero 2021: CRD42021272526).
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Affiliation(s)
- Carys Batcup
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd, Sydney, Australia
| | - Matilde Breth-Petersen
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd, Sydney, Australia
| | - Thomas Dakin
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd, Sydney, Australia
| | - Alexandra Barratt
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd, Sydney, Australia
| | - Forbes McGain
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd, Sydney, Australia
- Western Health, Department of Critical Care Medicine, University of Melbourne, Melbourne, Australia
| | - Ben R Newell
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Kristen Pickles
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd, Sydney, Australia.
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Scott S. Embedding education into clinical laboratory professional training to foster sustainable development and greener practice. Clin Chem Lab Med 2023; 61:638-641. [PMID: 36537086 DOI: 10.1515/cclm-2022-1152] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/09/2022] [Indexed: 02/08/2023]
Abstract
It has become apparent that the climate crisis is reaching critical levels and Governments and key organisations are recognising the need for change. A review of current literature reveals very little published research concerning the impact of clinical laboratory practice on the carbon footprint of healthcare. For a clinical laboratory to become more environmentally sound, key target areas of focus are required. With sustainability becoming a key consideration for course development, employing educational principles such as Education for Sustainable Development (ESD) in the form of Sustainability in Quality Improvement (SusQI), Quality Improvement objectives can be met, while benefitting the patient and the environmental impact of organisation.
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Moro C, McLean M, Phelps C. Embedding planetary health concepts in a pre-medical physiology subject. MEDICAL TEACHER 2023; 45:179-186. [PMID: 36070483 DOI: 10.1080/0142159x.2022.2118041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE There are increasing calls for planetary health (which includes sustainable healthcare) to be included in tertiary health professions education. With already busy curricula, particularly in medicine, educators need to find innovative ways of integrating these important concepts without adding to learners' workload. This study investigated whether planetary health concepts could be integrated into a Physiology subject as a stop-gap approach while longitudinal planning for longitudinal curriculum integration was underway. MATERIALS AND METHODS Each week, a planetary health fact (Did you know?) with a corresponding link were embedded at the bottom of a relevant PowerPoint lecture slide to match the topic of the week in a health science and medicine Physiology subject. The embedded facts were a mix of effects on health and the environmental impacts of healthcare activities, such as medical imaging. No other formal planetary health teaching was conducted in the subject. At the end of the semester, 44% of 100 students completed a survey regarding their perceptions of the planetary health inclusions. RESULTS Participants reported an appreciation of the facts, found them helpful for their overall learning, and were interested in learning about healthcare's large environmental footprint. Seventy-one percent were able to provide a reasonable definition of planetary health. Half of the participants reported their actions, behaviours, and thoughts had changed as a result of the planetary health inclusions. CONCLUSIONS This study provides a relatively simple approach for individual educators to include planetary health concepts into existing health professions subjects until more longitudinal curriculum revisions can be undertaken. Based on our findings, we would, however, recommend providing students with a brief introduction in terms of why planetary health has been included either at the start of the first lecture or as a 10-min video.
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Affiliation(s)
- Christian Moro
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Michelle McLean
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Charlotte Phelps
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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Williams JTW, Bell KJL, Morton RL, Dieng M. Exploring the Integration of Environmental Impacts in the Cost Analysis of the Pilot MEL-SELF Trial of Patient-Led Melanoma Surveillance. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:23-30. [PMID: 36195819 PMCID: PMC9834124 DOI: 10.1007/s40258-022-00765-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
AIMS Human health is intrinsically linked with planetary health. But planetary resources are currently being degraded and this poses an existential threat to human health and the sustainability of our healthcare systems. The aims of this study were to (1) describe an approach to integrate environmental impacts in a cost analysis; and (2) demonstrate this approach by estimating select environmental impacts alongside traditional health system and other costs using the example of the pilot MEL-SELF randomised controlled trial of patient-led melanoma surveillance. METHODS Economic costs were calculated alongside a randomised trial using standard cost analysis methodology from a societal perspective. Environmental impacts were calculated using a type of carbon footprinting methodology called process-based life cycle analysis. This method considers three scopes of carbon emissions: Scope 1, which occur directly from the intervention; Scope 2, which occur indirectly from the intervention's energy use; and Scope 3, which occur indirectly because of the value chain of the intervention. In this study we only included emissions from patient transport to attend their melanoma clinic over the study period of 6 months. RESULTS The environmental impact per participant across allocated groups for patient transport to their melanoma clinic was estimated to be 10 kg carbon dioxide equivalent. Economic costs across the allocated groups indicated substantial health system costs, out-of-pocket costs, and productivity losses associated with melanoma surveillance. The largest cost contributor was health system costs, and the most expensive category of health system cost was hospital admission. CONCLUSION Calculating environmental impacts is worthwhile and feasible within a cost analysis framework. Further work is needed to address outstanding conceptual and practical issues so that a comprehensive assessment of environmental impacts can be considered alongside economic costs in health technology assessments.
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Affiliation(s)
- Jake T W Williams
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Camperdown, NSW, Australia.
| | - Katy J L Bell
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Camperdown, NSW, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Mbathio Dieng
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
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Murphy MJ. Climate change and clinical biochemistry. Ann Clin Biochem 2023; 60:3-5. [PMID: 36411953 DOI: 10.1177/00045632221140991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Michael J Murphy
- Department of Biochemical Medicine, 3042Ninewells Hospital, Dundee, UK
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Drew J, Christie SD, Rainham D, Rizan C. HealthcareLCA: an open-access living database of health-care environmental impact assessments. Lancet Planet Health 2022; 6:e1000-e1012. [PMID: 36495883 DOI: 10.1016/s2542-5196(22)00257-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 08/17/2022] [Accepted: 10/18/2022] [Indexed: 06/17/2023]
Abstract
Anthropogenic environmental change negatively effects human health and is increasing health-care system demand. Paradoxically, the provision of health care, which itself is a substantial contributor to environmental degradation, is compounding this problem. There is increasing willingness to transition towards sustainable health-care systems globally and ensuring that strategy and action are informed by best available evidence is imperative. In this Personal View, we present an interactive, open-access database designed to support this effort. Functioning as a living repository of environmental impact assessments within health care, the HealthcareLCA database collates 152 studies, predominantly peer-reviewed journal articles, into one centralised and publicly accessible location, providing impact estimates (currently totalling 3671 numerical values) across 1288 health-care products and processes. The database brings together research generated over the past two decades and indicates exponential field growth.
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Affiliation(s)
- Jonathan Drew
- Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada.
| | - Sean D Christie
- Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada
| | - Daniel Rainham
- School of Health and Human Performance and the Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
| | - Chantelle Rizan
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK; Brighton and Sussex Medical School, Brighton, UK
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McAlister S, Morton RL, Barratt A. Incorporating carbon into health care: adding carbon emissions to health technology assessments. Lancet Planet Health 2022; 6:e993-e999. [PMID: 36495894 DOI: 10.1016/s2542-5196(22)00258-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 08/31/2022] [Accepted: 10/18/2022] [Indexed: 06/17/2023]
Abstract
At the UN Climate Change Conference 26 in Glasgow, 50 countries committed to low-carbon health services, with 14 countries further committing to net-zero carbon health services by 2050. Reaching this target will require decision makers to include carbon emissions when evaluating new and existing health technologies (tests and treatments). There is currently, however, a scarcity of data on the carbon footprint of health-care interventions, nor any means for decision makers to include and consider carbon emission health-care assessments. We therefore investigated how to integrate carbon emissions calculated by environmental life cycle assessment (LCA) into health technology assessments (HTA). HTAs are extensively used in developing clinical and policy guidelines by individual public or private payers, and by government organisations. In the first section we explain the methodological differences between environmentally extended input-output and process-based LCA. The second section outlines ways in which carbon emissions calculated by LCA could be integrated with HTAs, recognising that HTAs are done in several ways by different jurisdictions. International effort and processes will be needed to ensure that robust and comprehensive carbon footprints of commonly used health-care products are freely available. The technical and implementation challenges of incorporating carbon emissions into HTAs are considerable, but not unsurmountable. Our aim is to lay foundations for meeting these challenges.
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Affiliation(s)
- Scott McAlister
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Health Policy, Faculty of Medicine, Dentistry & Health Sciences, The University or Melbourne, Melbourne, VIC, Australia.
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Alexandra Barratt
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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King J, Poo SX, El-Sayed A, Kabir M, Hiner G, Olabinan O, Colwill M, Ayubi H, Shakweh E, Kronsten VT, Kader R, Hayee B. Towards NHS Zero: greener gastroenterology and the impact of virtual clinics on carbon emissions and patient outcomes. A multisite, observational, cross-sectional study. Frontline Gastroenterol 2022; 14:287-294. [PMID: 37409339 PMCID: PMC11138175 DOI: 10.1136/flgastro-2022-102215] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
Abstract
Objective The National Health Service (NHS) produces more carbon emissions than any public sector organisation in England. In 2020, it became the first health service worldwide to commit to becoming carbon net zero, the same year as the COVID-19 pandemic forced healthcare systems globally to rapidly adapt service delivery. As part of this, outpatient appointments became largely remote. Although the environmental benefit of this change may seem intuitive the impact on patient outcomes must remain a priority. Previous studies have evaluated the impact of telemedicine on emission reduction and patient outcomes but never before in the gastroenterology outpatient setting. Method 2140 appointments from general gastroenterology clinics across 11 Trusts were retrospectively analysed prior to and during the pandemic. 100 consecutive appointments during two periods of time, from 1 June 2019 (prepandemic) to 1 June 2020 (during the pandemic), were used. Patients were telephoned to confirm the mode of transport used to attend their appointment and electronic patient records reviewed to assess did-not-attend (DNA) rates, 90-day admission rates and 90-day mortality rates. Results Remote consultations greatly reduced the carbon emissions associated with each appointment. Although more patients DNA their remote consultations and doctors more frequently requested follow-up blood tests when reviewing patients face-to-face, there was no significant difference in patient 90-day admissions or mortality when consultations were remote. Conclusion Teleconsultations can provide patients with a flexible and safe means of being reviewed in outpatient clinics while simultaneously having a major impact on the reduction of carbon emissions created by the NHS.
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Affiliation(s)
- Jonathan King
- Department of Gastroenterology, Whittington Health NHS Trust, London, UK
| | - Stephanie X Poo
- Department of Gastroenterology, Hammersmith Hospitals NHS Trust, London, UK
| | - Ahmed El-Sayed
- Department of Gastroenterology, London North West University Healthcare NHS Trust, Harrow, UK
| | - Misha Kabir
- Department of Gastroenterology, Univeristy College Londn Hospitals NHS Foundation Trust, London, UK
| | - George Hiner
- Department of Gastroenterology, London North West University Healthcare NHS Trust, Harrow, UK
| | - Olaolu Olabinan
- Department of Gastroenterology, Brighton and Sussex University Hospitals NHS Trust, Worthing, UK
| | - Michael Colwill
- Department of Gastroenterology, Croydon University Hospital, Croydon, UK
| | - Homira Ayubi
- Department of Gastroenterology, King's College Hospital, London, UK
| | | | - Eathar Shakweh
- Department of Gastroenterology, Chelsea and Westminster Healthcare NHS Trust, London, UK
| | | | - Rawen Kader
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Wellcome/EPSRC Centre of Interventional and Surgical Sciences (WEISS), University College London, London, UK
| | - Bu'Hussain Hayee
- Department of Gastroenterology, King's College Hospital, London, UK
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Pearn L, Auret K, Pikora T. ‘What about the carbon?’ A call to count carbon costs prospectively to count carbon costs and savings in healthcare models. Intern Med J 2022; 52:2013. [DOI: 10.1111/imj.15946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/04/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Louise Pearn
- University of Western Australia Rural Clinical School of Western Australia Esperance Western Australia Australia
| | - Kirsten Auret
- University of Western Australia Rural Clinical School of Western Australia Esperance Western Australia Australia
| | - Terri Pikora
- University of Western Australia Rural Clinical School of Western Australia Esperance Western Australia Australia
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Affiliation(s)
- William K Silverstein
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Choosing Wisely Canada, Toronto, ON, Canada
| | - Adina S Weinerman
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada
| | - Karen Born
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University Toronto, Toronto, ON, Canada
| | | | - Christopher P Moriates
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Costs of Care, Boston, MA, USA
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Schmidt L, Bohnet-Joschko S. Planetary Health and Hospitals' Contribution-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013536. [PMID: 36294116 PMCID: PMC9603437 DOI: 10.3390/ijerph192013536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 05/28/2023]
Abstract
Climate change is one of the greatest global threats for planetary and human health. This leads to new challenges for public health. Hospitals emit large amounts of greenhouse gases (GHG) in their healthcare delivery through transportation, waste and other resources and are considered as key players in reducing healthcare's environmental footprint. The aim of this scoping review is to provide the state of research on hospitals' carbon footprint and to determine their contribution to mitigating emissions. We conducted a systematic literature search in three databases for studies related to measurement and actions to reduce GHG emissions in hospitals. We identified 21 studies, the oldest being published in 2012, and the most recent study in 2021. Eight studies focused on GHG emissions hospital-wide, while thirteen studies addressed hospital-based departments. Climate actions in the areas of waste and transportation lead to significant reductions in GHG emissions. Digital transformation is a key factor in implementing climate actions and promoting equity in healthcare. The increasing number of studies published over time indicates the importance of the topic. The results suggest a need for standardization of measurement and performance indicators on climate actions to mitigate GHG emissions.
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Affiliation(s)
- Lesly A Dossett
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Anthony L Edelman
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Shannon M Ruzycki
- Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Breth-Petersen M, Bell K, Pickles K, McGain F, McAlister S, Barratt A. Health, financial and environmental impacts of unnecessary vitamin D testing: a triple bottom line assessment adapted for healthcare. BMJ Open 2022; 12:e056997. [PMID: 35998953 PMCID: PMC9472108 DOI: 10.1136/bmjopen-2021-056997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 06/30/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To undertake an assessment of the health, financial and environmental impacts of a well-recognised example of low-value care; inappropriate vitamin D testing. DESIGN Combination of systematic literature search, analysis of routinely collected healthcare data and environmental analysis. SETTING Australian healthcare system. PARTICIPANTS Population of Australia. OUTCOME MEASURES We took a sustainability approach, measuring the health, financial and environmental impacts of a specific healthcare activity. Unnecessary vitamin D testing rates were estimated from best available published literature; by definition, these provide no gain in health outcomes (in contrast to appropriate/necessary tests). Australian population-based test numbers and healthcare costs were obtained from Medicare for vitamin D pathology services. Carbon emissions in kg CO2e were estimated using data from our previous study of the carbon footprint of common pathology tests. We distinguished between tests ordered as the primary test and those ordered as an add-on to other tests, as many may be done in conjunction with other tests. We conducted base case (8% being the primary reason for the blood test) and sensitivity (12% primary test) analyses. RESULTS There were a total of 4 457 657 Medicare-funded vitamin D tests in 2020, on average one test for every six Australians, an 11.8% increase from the mean 2018-2019 total. From our literature review, 76.5% of Australia's vitamin D tests provide no net health benefit, equating to 3 410 108 unnecessary tests in 2020. Total costs of unnecessary tests to Medicare amounted to >$A87 000 000. The 2020 carbon footprint of unnecessary vitamin D tests was 28 576 kg (base case) and 42 012 kg (sensitivity) CO2e, equivalent to driving ~160 000-230 000 km in a standard passenger car. CONCLUSIONS Unnecessary vitamin D testing contributes to avoidable CO2e emissions and healthcare costs. While the footprint of this example is relatively small, the potential to realise environmental cobenefits by reducing low-value care more broadly is significant.
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Affiliation(s)
| | - Katy Bell
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kristen Pickles
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Forbes McGain
- Department of Critical Care, The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Western Health, Melbourne, Victoria, Australia
| | - Scott McAlister
- Department of Critical Care, The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Alexandra Barratt
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Thiel C, Richie C. Carbon Emissions from Overuse of U.S. Health Care: Medical and Ethical Problems. Hastings Cent Rep 2022; 52:10-16. [PMID: 35993105 DOI: 10.1002/hast.1404] [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] [Indexed: 11/06/2022]
Abstract
The United States health care industry is the second largest in the world, expending an estimated 479 million metric tons (MMT) of carbon dioxide per year, nearly 8 percent of the country's total emissions. The importance of carbon reduction in health care is slowly being accepted. However, efforts to "green" health care are incomplete since they generally focus on buildings and structures. Yet hospital care and clinical service sectors contribute the most carbon dioxide within the U.S. health care industry, with structures/equipment and pharmaceuticals ranking as the third and fourth highest emitters in the industry. Given the magnitude of health care carbon emissions-and the paucity of attention to the carbon of hospital care and clinical services-this essay identifies overuse of health care as a health threat with serious ethical implications, offers a data-driven action plan for carbon reduction in health care, and provides practical suggestions for more sustainable health care delivery in the United States.
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Walsh O, Harris R, Flower O, Anstey M, McGain F. Everyone's a winner if we test less: the CODA action plan. AUST HEALTH REV 2022; 46:460-462. [PMID: 35772927 DOI: 10.1071/ah22145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022]
Abstract
In this era of 'Choosing Wisely,' we present a four-step action plan to reduce unnecessary pathology testing and the associated patient harm (blood loss through repeated phlebotomy), economic cost and environmental impact. The authors are experts from the CODA group; a medical education and health-promotion charity that aims to build on the Choosing Wisely initiative to provide meaningful and sustainable actions to reduce the carbon footprint of healthcare, globally. Pathology testing is expensive and carbon-intensive, with as many as half of all tests being not clinically indicated. Reducing unnecessary testing is the only effective way to decrease the carbon footprint and other associated costs, as opportunities to reuse and recycle pathology specimens are limited. The four key steps for action are (i) auditing local practice; (ii) defining unnecessary testing including developing a clinical guideline for rational ordering; (iii) educating stakeholders; and (iv) measuring the impact of the intervention through re-audit. This proven method is designed to be used in any healthcare setting around the world; having a small group of passionate 'champions' is thought to be as important as strong clinical governance and more important than access to sophisticated equipment. Electronic medical record systems and other technological solutions offer new ways to help establish a sustainability mindset and reduce unnecessary testing. The Codachange.org/coda-earth/ website provides a dynamic crowdsourcing platform through which we can collectively learn to meet the diverse needs of our international medical community. Self-reported outcomes are gamified through collaborative feedback, amplification via social media and the ability to earn rewards, be uploaded to the CODA website, or added to the template as a success story. By combining our existing local networks with the emerging international CODA community, we can initiate meaningful change now and enter the era of environmental stewardship.
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Affiliation(s)
- Oliver Walsh
- Intensive Care Unit, The Canberra Hospital, ACT, Australia; and College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Roger Harris
- Intensive Care Unit, Royal North Shore Hospital, Sydney, NSW, Australia; and Faculty of Health and Medicine, Sydney University, NSW, Australia
| | - Oliver Flower
- Intensive Care Unit, Royal North Shore Hospital, Sydney, NSW, Australia; and Faculty of Health and Medicine, Sydney University, NSW, Australia
| | - Matthew Anstey
- Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia; and School of Public Health, Curtin University, Perth, WA, Australia
| | - Forbes McGain
- Departments of Anaesthesia and Intensive Care, Western Health, Vic., Australia; and Department of Critical Care, University of Melbourne, Vic., Australia
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McAlister S, McGain F, Petersen M, Story D, Charlesworth K, Ison G, Barratt A. The carbon footprint of hospital diagnostic imaging in Australia. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 24:100459. [PMID: 35538935 PMCID: PMC9079346 DOI: 10.1016/j.lanwpc.2022.100459] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Pathology testing and diagnostic imaging together contribute 9% of healthcare's carbon footprint. Whilst the carbon footprint of pathology testing has been undertaken, to date, the carbon footprint of the four most common imaging modalities is unclear. METHODS We performed a prospective life cycle assessment at two Australian university-affiliated health services of five imaging modalities: chest X-ray (CXR), mobile chest X-ray (MCXR), computerised tomography (CT), magnetic resonance imaging (MRI) and ultrasound (US). We included scanner electricity use and all consumables and associated waste, including bedding, imaging contrast, and gloves. Analysis was performed using both attributional and consequential life cycle assessment methods. The primary outcome was the greenhouse gas footprint, measured in carbon dioxide equivalent (CO2e) emissions. FINDINGS Mean CO2e emissions were 17·5 kg/scan for MRI; 9·2 kg/scan for CT; 0·8 kg/scan for CXR; 0·5 kg/scan for MCXR; and 0·5 kg/scan for US. Emissions from scanners from standby energy were substantial. When expressed as emissions per additional scan (results of consequential analysis) impacts were lower: 1·1 kg/scan for MRI; 1·1 kg/scan for CT; 0·6 kg/scan for CXR; 0·1 kg/scan for MCXR; and 0·1 kg/scan for US, due to emissions from standby power being excluded. INTERPRETATION Clinicians and administrators can reduce carbon emissions from diagnostic imaging, firstly by reducing the ordering of unnecessary imaging, or by ordering low-impact imaging (X-ray and US) in place of high-impact MRI and CT when clinically appropriate to do so. Secondly, whenever possible, scanners should be turned off to reduce emissions from standby power. Thirdly, ensuring high utilisation rates for scanners both reduces the time they spend in standby, and apportions the impacts of the reduced standby power of a greater number of scans. This therefore reduces the impact on any individual scan, maximising resource efficiency. FUNDING Healthy Urban Environments (HUE) Collaboratory of the Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise MBG SPHERE. The National Health and Medical Research Council (NHMRC) PhD scholarship.
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Affiliation(s)
- Scott McAlister
- The Centre for Health Policy, The University of Melbourne, Australia, Wiser Healthcare and Faculty of Medicine and Health, The University of Sydney, Australia, and Department of Critical Care, The University of Melbourne, Grattan St, Parkville, VIC 3010, Australia
- Corresponding author.
| | - Forbes McGain
- Department of Critical Care, The University of Melbourne, Australia and Western Health, Melbourne, Australia
| | - Matilde Petersen
- Wiser Healthcare and Faculty of Medicine and Health, The University of Sydney, Australia
| | - David Story
- Department of Critical Care, The University of Melbourne, Australia
| | | | - Glenn Ison
- Department of Cardiology, St George Hospital, Sydney, Australia
| | - Alexandra Barratt
- Wiser Healthcare and Faculty of Medicine and Health, The University of Sydney, Australia
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Badrick T. The Role of Laboratories in Reducing the Carbon Footprint. Am J Clin Pathol 2022; 158:322-324. [PMID: 35726682 DOI: 10.1093/ajcp/aqac056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tony Badrick
- Royal College of Pathologists of Australasia Quality Assurance Programs , St Leonards , Australia
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The Unintended Contribution of Clinical Microbiology Laboratories to Climate Change and Mitigation Strategies: A Combination of Descriptive Study, Short Survey, Literature Review and Opinion. Clin Microbiol Infect 2022; 28:1245-1250. [DOI: 10.1016/j.cmi.2022.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 11/21/2022]
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