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Hospitals Curbing Emissions Switch Anesthesia Gases, Plug Leaks

July 7, 2022, 9:35 AM

Hospitals under growing pressure to curb their greenhouse gas emissions are finding that taking a fresh look at how they use anesthesia can have a big payoff.

Tackling emissions from anesthesia gases, which make up about 5% of a hospital’s carbons emissions, requires simple switches that can have a substantial effect with very little downside, said anesthesiologists and health system executives.

That insight from health system executives comes as pressure mounts on the health-care industry to address its greenhouse gas emissions. The health sector accounts for 8.5% of the nation’s greenhouse gas emissions—almost as much as agriculture—and the Department of Health and Human Services has asked hospitals, health suppliers, drug companies and others in the industry to pledge to reduce their emissions to net zero by 2050.

Thus far, 61 hospital systems, insurers, pharmaceutical companies, and other organizations have signed the HHS pledge, the HHS said. They originally had until June 10 to do so, but the department decided to reopen the initiative and will allow additional signatories until Oct. 28, Assistant Secretary for Health Rachel Levine said at a White House event June 30.

Levine said she was pleased by the response so far, but “it’s not sufficient. We need to get many more hospitals, health systems, businesses in the supply chain involved to accomplish our goals.”

‘Good Poster Child’

Anesthesia gases are a “good poster child” for the direct climate impact from hospitals, said Matthew Meyer, co-chair of the University of Virginia health sustainability committee and a professor of anesthesiology. The simplest and most impactful way to reduce the carbon footprint of an operating room is with anesthetic gases, he said.

Anesthesiologists have several choices of drugs and inhaled anesthetic gases to use, some of which have substantial impacts on the environment.

Meyer has made two switches in his practice in recent years. He stopped using desflurane, the inhaled anesthetic that has the greatest carbon impact, as there is rarely a clinical need for it; and he started using sevoflurane more often, which has less of an impact.

He also began using the intravenous anesthetic propofol more frequently, since it has even less of a carbon footprint than sevoflurane.

Reducing Leaks, Saving Money

Officials at Providence Health, which operates 51 hospitals and more than 800 other facilities in seven states, began looking at the problem on an even greater scale.

They determined that much of their nitrous oxide emissions were “largely driven by leaks,” said Brian Chesebro, medical director of environmental stewardship at Providence Health and Services and an anesthesiologist. As a greenhouse gas, nitrous oxide is 300 times more potent than carbon dioxide.

Typically, nitrous oxide is supplied from huge tanks in a hospital’s basement and piped around to each room that needs it. However, that is where all the leaks originate. The hospital system found it was wasting 95% to 98% of what it was buying.

The hospital system tried to put smaller nitrous oxide tanks in each operating room to “eliminate the potential for leak in these tremendously complex systems,” Chesebro said. Officials found they cut down that waste to less than 1%.

These changes “actually do move the needle. By getting rid of desflurane and getting rid of nitrous oxide, you really can change an entire health system’s footprint,” Meyer said.

Addressing anesthesia gas leaks and clinical choices led to a 95% reduction in those emissions to the Providence hospitals in the Oregon region and a 70% associated cut in cost, Chesebro said. The whole Providence system saved $2.38 million in 2021, a cost savings of 56%, he said.

This “is a really effective project because you get these two co-benefits that can occur and accrue really quickly,” he said.

Leadership Buy-In

Few hospital systems have made addressing climate change a priority up until now.

Conversations in recent years “didn’t get the same attention. And now people are really understanding that climate change impacts health,” said Seema Wadhwa, executive director of environmental stewardship for Kaiser Permanente, which operates 39 hospitals and more than 700 medical offices in eight states and the District of Columbia.

Making these kinds of changes at hospitals requires leadership at the top to support the work, administrators said.

Beth Schenk, executive director of environmental stewardship at Providence, said for many years the climate efforts were “mostly grassroots and with less leadership support and fewer resources. And you can do a lot, but really can’t move the big boulders.”

After getting leadership on board, Providence was able to make the large-scale changes they needed to make, including getting everyone to factor it into “their day-to-day decision making either as clinicians or facilities engineers or administrators,” Chesebro said.

An Assist From HHS

Now, HHS has the work of helping hospital systems that signed the climate pledge to accomplish the outlined goals.

“It’s been very important to us from the outset that we’re not sending the message here that we want to encourage people to sign this pledge and say, ‘Great, you’ve signed the pledge, you’re on your own,’” said Joe McCannon, health sector lead for the HHS Office of Climate Change and Health Equity.

The HHS plans to host a webinar in the coming weeks to tell those health-care providers that have signed its pledge “what we’re going to do, what we’re putting on the table, how we’re going to make investments,” HHS Secretary Xavier Becerra said at the White House June 30.

The federal government plans to “put some resources on the tables to help finance some of the work that has to get done,” including for renewable infrastructure and quantifying measures, he said.

The HHS’s Agency for Healthcare Research and Quality will be putting out a toolkit “to support measurement and data collection and initial actions on decarbonization,” Levine said.

To contact the reporter on this story: Shira Stein in Washington at sstein@bloomberglaw.com

To contact the editor responsible for this story: Brent Bierman at bbierman@bloomberglaw.com