JMIR Publications

ABSTRACT

Background:

Inhaled anesthetics in the operating room are potent greenhouse gases and are a key contributor to carbon emissions from healthcare facilities. Real-time clinical decision support (CDS) systems lower anesthetic gas waste by prompting anesthesia providers to reduce fresh gas flows (FGF) when a set threshold is exceeded. However, previous CDS systems have relied on proprietary or highly customized anesthesia management systems, significantly reducing accessibility of the technology to other institutions, and thus limiting overall environmental benefit.

Objective:

We developed a CDS that lowers anesthetic gas waste using methods that can be easily adopted by other institutions. To facilitate wider uptake of our CDS and further reduce gas waste, we describe the implementation of the FGF CDS toolkit at University of California, San Francisco (UCSF), and subsequent implementation at other medical campuses within the University of California health network.

Methods:

We developed a non-interruptive, active CDS system to alert anesthesia providers when FGF rates exceeded 0.7 L/min for common volatile anesthetics. Prior to implementation, presentation-based education initiatives were used to disseminate information regarding the safety of low FGF use and its relation to environmental sustainability. Our FGF CDS toolkit consisted of four main components for implementation: 1) sustainability-focused education of anesthesia providers, 2) hardware integration of the CDS technology, 3) software build of the CDS, and 4) data reporting of measured outcomes.

Results:

The FGF CDS system was successfully deployed at five UC Health Network campuses. Each campus made modifications to the CDS tool to best suit their institution, emphasizing the versatility and adoptability of the technology and implementation framework.

Conclusions:

It has previously been shown that the FGF CDS reduces anesthetic gas waste, leading to environmental and fiscal benefits. Here we demonstrate that the CDS can be transferred to other medical facilities using our toolkit for implementation, making the technology and associated benefits globally accessible to advance mitigation of healthcare-related emissions.