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Collaborative Care for the Planet

Vancouver Coastal Health Enhanced Recovery After Surgery team members: Amy Myring and Julie Nakahara.

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BC’s cooperative push towards sustainable clinical practices

While the health care sector has always been dedicated to promoting health and well-being, the system also has significant environmental costs. Health care contributes up to 5 per cent of global greenhouse gas emissions. Recognizing the urgent need to reduce this carbon footprint, BC’s Low-Carbon, High-Quality Care Collaborative is tackling emissions with a focus on perioperative care and respiratory medicine. Led by Health Quality BC (HQBC), in partnership with CASCADES Canada, Vancouver Coastal Health’s Planetary Health Department, and several BC Health Organizations, this initiative aims to lower the carbon impact of health care while improving patient care.

The collaborative launched in 2023:

  • mobilizing 18 Action & Improvement Teams,
  • composed of 100 participants,
  • across 23 sites throughout the province.

Their goal is to reduce the carbon emissions from clinical practices by 10 per cent by November 2024. To accomplish this, the collaborative is focused on practical changes in clinical settings, such as optimizing anesthetic gas use, curtailing unnecessary pre-operative testing, and transitioning to reusable medical items.

A notable aspect of this work is its provincially coordinated, patient-centered approach. Leveraging HQBC’s partnerships with patients and communities, care providers, health leaders, policymakers, senior executives, and academics, it is responsive to the unique dynamics of BC’s health care system and builds capacity where it is needed the most.

At Vancouver Coastal Health (VCH), two teams are rethinking and reshaping routine medical practices to reduce emissions and effectively enhance the quality of patient care.

The Enhanced Recovery After Surgery (ERAS) Coordinators at VCH are driving down emissions by implementing evidence-based guidelines that shorten the length of hospital stays. This reduction is better for patient recovery and decreases the energy consumed and waste generated in longer stays. By meticulously reviewing patient charts, collecting data on outcomes, and sharing their findings, this team reduced their annual carbon emissions by an estimated 1507 kg CO2e. Their data-driven approach to integrating environmental sustainability into clinical care processes is already a resounding success.

Meanwhile, another VCH team is tackling the environmental impact of asthma and chronic obstructive pulmonary disease treatments by focusing on the carbon emissions from metered-dose inhalers. Composed of internal medicine physicians, pharmacists, and respiratory therapists, this team undertook a detailed analysis of inhaler usage and dispensing patterns. They also rolled out an education campaign aimed at promoting the prescription of lower-carbon alternatives and are developing strategies to use electronic medical records to prevent over-prescription of traditional high-carbon inhalers.

While the initiative has a clinical focus, one of the best outcomes thus far is the community of practitioners, clinicians, and other contributors who share a purpose and passion. As Andrea Wnuk, Leader of Health System Improvement at HQBC, notes, “It’s been extremely inspiring to be a part of this work. I’m in awe of the excitement, engagement, and dedication to reduce the carbon footprint of clinical care while maintaining high-quality care for patients across BC.”

Andrea MacNeill, VCH Regional Planetary Health Medical Director, emphasizes the broader implications:

Participating in the collaborative is a meaningful and effective way to spread clinical practice changes that improve the quality of care, with a lower carbon footprint.”

As the project heads towards its conclusion in November 2024, the focus will shift to the tangible results and future possibilities of this climate-conscious approach to health care. This initiative will serve as a blueprint for sustainable clinical practices across Canada and beyond.