How we’re improving our chemical and anesthetic use

Monday, February 6, 2023

Providence developed the WE ACT framework to focus on five key areas of environmental stewardship: Waste, energy and water, agriculture and food, chemicals, and transportation.
Some chemicals are greenhouse gases, including volatile anesthetic gases and nitrous oxide, which require responsible management and stewardship.
Providence has drastically reduced greenhouse gas emissions from anesthetic gases while encouraging the use of more environmentally friendly anesthetic agents and improving the efficiency of our clinical infrastructure.

Our health and our planet’s health are connected in unique ways, which is why Providence is committed to our goal of being carbon negative by 2030. Providence ministries are dedicated to finding innovative environmental stewardship solutions that support our planet and our patients, including through chemical management. Chemicals, along with waste, energy and water, agriculture, and transportation, are part of our WE ACT Framework and Scorecard which we use to identify, measure and address emissions throughout our system.

While many industries beyond health care are working to address resources like water and energy usage, some aspects of our WE ACT Framework are unique to health care. One of those areas, when it comes to chemicals, is the management of medical gases, including volatile anesthetics and nitrous oxide. As part of our Environmental Stewardship commitment, Providence has been focused on selecting the most effective anesthetic agents which also have lower greenhouse gas emissions.

“We take our emissions very seriously,” says Dr. Brian Chesebro, Anesthesiologist and Medical Director of Environmental Stewardship for Providence “Using a data-driven approach, we have been able to reduce emissions significantly while saving millions of dollars and maintaining patient safety.”

Through these efforts, Providence has decreased greenhouse gas emissions from anesthesia by 78%, leading to $2.4 million in annual savings.

Chemical use at Providence

Many chemicals can be used safely throughout health care, but some chemicals, including anesthetics, require extra care, management and, ultimately, reduction. That’s because anesthetics account for up to 40% of hospitals’ scope 1 greenhouse gas emissions, according to Providence data. These chemicals include medical gases like:

Volatile anesthetics: desflurane, isoflurane and sevoflurane
Nitrous oxide

Nitrous oxide is a medical gas, most commonly used as an adjunct to general anesthesia, that often contributes more greenhouse gas emissions than all other volatile anesthetics combined. This gas is often delivered to operating rooms through wall pipe systems.

Unfortunately, the piped system that delivers nitrous oxide is often inefficient, losing up to 95% of the gas in the system. That is why Providence is working to decommission nitrous oxide and eliminate piped systems in new buildings. Using data from our electronic health record, the team worked toward a solution to decommission the piped system and use portable cylinders instead, reducing gas loss in some cases by 99%.

Collaboration with Caregivers

In addition to infrastructure improvements, Providence worked with caregivers to encourage clinical management decisions that reduce volatile anesthetic gas emissions. These caregivers focused on increasing the overall value of care by reducing costs (environmental, financial) while maintaining or improving the quality of patient care across the following:

Safety
Efficacy
Efficiency
Equity
Patient-centeredness
Resilience
Compliance

The team completed a decarbonization value analysis of these anesthetic agents and encouraged caregivers to rethink how they deliver anesthesia. The result was identifying opportunities for improvement and implementing new practices that prevent leakage of these chemicals into the environment, including shifting to anesthetic agents with lower greenhouse gas emissions, while maintaining efficacy and safety for patients.

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