Outcome statementTransitioning to modern, high quality, low carbon models of care for our patients, guided by the principles of sustainable healthcare.
Transitioning to modern, high quality, low carbon models of care for our patients, guided by the principles of sustainable healthcare.
The Net Zero Government Operations Policy sets a range of actions for 黑料吃瓜网 Health targeting scope 1, 2 and 3 emissions. It outlines requirements for the health system to identify its largest scope 3 emissions sources and make plans to address them.
Clinical care - providing high quality healthcare to our patients - is at the heart of 黑料吃瓜网 Health. Our clinicians - nurses, doctors, and allied health professionals - will all play a crucial role in developing modern high quality, low carbon models of care. National and international research demonstrates that more than half of healthcare鈥檚 carbon footprint is supply chain emissions from clinical care (pharmaceuticals, medical devices, equipment etc).4 The evidence 鈥� and increasingly our own experience in 黑料吃瓜网 Health 鈥� demonstrates that we can improve health outcomes and patient experience, whilst reducing waste and carbon emissions.
Three principles of sustainable healthcare guide our approach to reducing emissions:
The consultation process confirmed what is working well in the system and identified priorities and areas that are in most need of improvement.
There were many examples of what is working well shared during the consultation, including:
Moving forward there is a need to scale existing best practice, including:
Anaesthetic gases comprise ~2% of NSLHD鈥檚 carbon footprint. One gas, desflurane, has a global warming potential (GWP100) that is 2,540 times greater than carbon dioxide, making it a potent greenhouse gas.7 In 2022, a team of anaesthetists at NSLHD set about reducing the impact of desflurane by encouraging a switch to using alternative and less polluting anaesthetic gases while continuing to deliver safe, high-quality healthcare.
A multifaceted project was implemented across the district, including a staff education and awareness raising campaign, training to support practice changes, and audits to monitor desflurane use.
The project was successful in significantly reducing desflurane use from 35 bottles per month to only four bottles over the 2022/23 financial year at Royal North Shore Hospital. This is equal to a reduction of carbon emissions from 1,321 tonnes to 0.75 tonnes. A direct cost saving of $344,087 and a global social cost saving of $105,048 per year was also calculated.8
Subsequently, the 黑料吃瓜网 Medicines Formulary Committee endorsed the decision to remove desflurane from the Formulary.
The 黑料吃瓜网 Medicines Formulary Committee endorsed a decision to remove desflurane from the Formulary, effective from March 2024.
Many health systems in Australia and internationally are phasing out desflurane, and its use in 黑料吃瓜网 Health has reduced substantially in recent years as anaesthetists shift towards safe, clinically equivalent and less polluting alternatives.
The Committee cited three reasons for the decision: the availability of safe and clinically equivalent alternatives to desflurane, the high cost of desflurane and concerns about desflurane鈥檚 environmental impact.
NSLHD has established an Australian first Net Zero Leads Program which supports clinicians to lead a project to reduce emissions in their specialty or service. Twelve clinicians from anaesthetics and surgery, endocrinology, respiratory medicine, paediatrics, nursing, pharmacy and physiotherapy are supported half to one day/week by the NORTH Foundation, to research and deliver a net zero project.
To support 黑料吃瓜网 Local Health Districts and Specialty Health Networks, the Climate Risk and Net Zero Unit piloted a Net Zero Leads program. Ten clinicians across nursing, medicine and allied health disciplines were supported 0.2FTE each to lead a net zero project in their service or specialty and embed net zero carbon principles into the delivery of care. More than half of the Net Zero Leads were appointed from regional LHDs. The Leads addressed known carbon hotspots in anaesthetics, critical care, theatres, and pharmacy.
Given the success of the pilot, an expanded program of multi-disciplinary hubs was launched in November 2024. Seven hubs were established across known carbon hotspots including surgery, ICU, ED, renal, endoscopy, paediatrics and infection prevention services. The hubs are responsible for becoming exemplars and guiding decarbonisation activities across the state, in their service or specialty.
It is estimated that Hunter New England Local Health District uses almost ~28.3 million gloves, producing 100 tonnes of waste and a carbon footprint of 1000 tonnes CO2e.
The Gloves Off! project at John Hunter Hospital, aimed to improve hand hygiene and reduce unnecessary non-sterile glove use through the implementation of a targeted hand hygiene education program.
The project was successful in improving staff capability in performing standard precautions risk assessments, improving patient care, saving money, reducing waste and minimising Hunter New England LHD鈥檚 carbon footprint.
Unnecessary glove use reduced from 60% pre- intervention to 31% post-intervention and 23% at six-month follow-up.
Hand hygiene compliance improved from 59% pre- intervention to 69% post-intervention and 83% at six-month follow-up. Ward glove purchase numbers reduced by 21%. The project achieved a waste reduction of 260kg and carbon savings of 2,566 kgCO2e, which equates to an equivalent carbon footprint of driving a fuel-efficient petrol car 7,000km (approximately halfway around Australia).
Historically, there has been limited reuse of PAP devices, including both CPAP and NIV devices, within 黑料吃瓜网 Health loan pools and equipment allocation programs for home use.
One of the 2022/23 Sustainable Futures Innovation Fund projects investigated the presence of bacteria in air samples taken from PAP devices to develop an evidence base to support the re-purposing of respiratory equipment and guideline development.
The benchtop proof of concept study demonstrated that the risk of transmission of viable bacteria in air flow is very low; with surface swabs showing that current cleaning procedures were sufficient for removing any organisms of concern from the external surfaces. The study鈥檚 findings support equipment re-use and the implementation of the Enable 黑料吃瓜网 Going Circular Project.
Prolonged use of IV antimicrobial therapy to treat severe infections is common. Unnecessary prolonged use can lead to patient harm, increased risk of antimicrobial resistance and healthcare associated costs. Best practice recommendations are for processes to flag safe early IV to PO switch for antimicrobials.
One of the 2022/23 Sustainable Futures Innovation Fund project teams developed and implemented a clinical decision support tool to triage prescribed IV antimicrobial orders for a post-prescription review. The Antimicrobial Stewardship team and pharmacists are alerted to these orders when a patient meets the algorithm, pre-defined by the Clinical Applications Advisory Group for AMS. The indications list included respiratory, intraabdominal, and urological infections.
The project resulted in a 1.7-fold increase in accepting AMS recommendations to switch IV to PO, when compared to 2022. When an appropriate IV to PO switch occurred, there was a reduced Length of Stay.
More than 20 million respiratory inhalers are prescribed annually in Australia. While inhalers are essential for managing respiratory illnesses, single pressurised meter dose inhalers also have a substantial carbon footprint.
For example, some pressurised meter dose inhalers emit as much carbon dioxide as a car trip from Sydney to Canberra.
Sophie Timmins, Respiratory and Sleep Medicine Physician, and her fellow Net Zero Leads at Royal North Shore Hospital tackled this issue. One of the initiatives was an inhaler collection pilot, which led to a 12-month inhaler and medication blister pack recycling program.
鈥淭hrough an audit, we identified high-use wards and collected 122 inhalers over eight weeks, many with remaining doses,鈥� she said. 鈥淭he new recycling program will introduce designated bins for empty blister packs and inhalers in inpatient wards, which we are hoping to roll out across the district if successful.鈥�
The team developed a staff educational campaign to ensure the correct disposal of inhalers and developed an asthma pathway for the Royal North Shore Hospital emergency department.
