Harriet W. Hopf, M.D., FASA, is Professor of Anesthesiology and Biomedical Engineering, University of Utah

Harriet W. Hopf, M.D., FASA, is Professor of Anesthesiology and Biomedical Engineering, University of Utah

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Brian B. Chesebro, M.D., is Medical Director, Environmental Stewardship and Sustainability, Providence Health and Services, Oregon Anesthesiology Group PC, Portland.

Brian B. Chesebro, M.D., is Medical Director, Environmental Stewardship and Sustainability, Providence Health and Services, Oregon Anesthesiology Group PC, Portland.

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Jodi D. Sherman, M.D., is Associate Professor of Anesthesiology and Associate Professor of Epidemiology in Environmental Health Sciences, Yale University School of Medicine and Yale School of Public Health, New Haven, Connecticut.

Jodi D. Sherman, M.D., is Associate Professor of Anesthesiology and Associate Professor of Epidemiology in Environmental Health Sciences, Yale University School of Medicine and Yale School of Public Health, New Haven, Connecticut.

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For over 30 years, the Foundation for Anesthesia Education and Research (FAER) has been dedicated to developing the next generation of physician-scientists in anesthesiology. Funding mechanisms span medical students, residents, fellows and early career faculty members. FAER Research Fellowship Grants (RFG), Mentored Research Training Grants (MRTG), Research in Education Grants (REG) and Transition to Independence Grants (TIG) support anesthesiologists to develop the skills and gather the preliminary data they need to become independent, federally funded investigators in basic science, clinical, translational, health services and education research.

An important decision when embarking on a research career is the selection of a focused research area. Choosing research questions that are personally inspiring and are recognized as important by the specialty and funding agencies is an important first step. An emerging field of research that has broad impact across multiple disciplines and will be increasingly valued by funding agencies is the environmental and public health impact of anesthetic practice. In turn, this area of study is part of a larger discipline: health care sustainability research.

Climate change is widely recognized as the greatest public health threat of the 21st century.1  It is presently responsible for an estimated 150,000 deaths per year, from hazards such as extreme weather events, poor air quality, food- and water-borne illness, vector-borne disease, food and water insecurity, and social instability. That number is expected to almost double over the next 30 years. Ironically, the provision of health care contributes substantially to environmental pollution and climate change; in the U.S., health care is responsible for 9% of criteria air pollutants, 10% of greenhouse gases (excluding waste anesthetic gases which are also potent greenhouse gases) and 5.9 million tons of solid waste per year (about one-third of which is produced by surgical services).2  Health damages from health care sector-produced pollutants are estimated at 614,000 disability-adjusted life-years lost, commensurate with the 44,000-98,000 people who are estimated to die in hospitals each year in the U.S. as a result of preventable medical errors.2,3  Reducing these health care pollution impacts requires a patient safety movement similar to that engendered by the 1999 Institute of Medicine report To Err is Human. The success of that effort, as with all patient safety initiatives, depends on high quality research that defines potential interventions and measures outcomes.

Health care sustainability research directly addresses improving the quality, safety and value of health care through critical evaluation of resource consumption and environmental emissions associated with health care activities. As with most research in anesthesiology, this requires the contributions of a broad range of disciplines, including engineering, sustainability science, medicine, public health, health policy, health care economics and health systems management. As in other areas of patient safety, anesthesiologists have taken the lead in health care sustainability research, particularly in the area of Life Cycle Analysis, a powerful tool critical to comparative assessments of the environmental impact of anesthetic practices.4 

Numerous opportunities remain in a variety of disciplines, across the full range of FAER-supported domains: basic science, clinical, translational, health services and education research.

Strategic areas for investigation include:5 

  • ■ Development of a life-cycle inventory database (“cradle-to-gate”), similar to other standardized international databases of environmental emissions for basic materials, but for whole medical products (pharmaceuticals and medical devices); this will serve as a standardized resource for Life Cycle Assessment (applied study of those products’ emissions),

  • ■ Engineering of better processes for managing pharmaceutical, vapor anesthetic and solid waste management from the operating room, intensive care unit and pain management clinic,

  • ■ Pharmaceutical and medical device design for reuse (ease of cleaning), with greener materials and processing, and with transparent and standardized environmental impact assessments to inform decision makers,

  • ■ Cost-benefit analyses of infection control measures that include environmental and public health impacts,

  • ■ Development of waste-sparing approaches to anesthetic management,

  • ■ Development of environmentally preferable clinical care pathways and approaches to resource management,

  • ■ Development of provider-level, hospital and national health system environmental performance metrics with international benchmarks,

  • ■ Development and evaluation of educational programs to advance the implementation of environmental impact into anesthetic practice.

Given the broad reach of sustainability science into multiple disciplines of health care, concerted academic effort should be made to integrate environmental impact assessments into decision making at all levels. For example, the study of clinical best practices should be expanded to include optimization of resource efficiency and pollution prevention, in addition to patient outcomes. Databases and tools should be integrated into electronic health records and procurement information management systems, to support research, environmentally preferable practices and benchmarking. Embracing and adopting such perspectives would undoubtedly serve to benefit both public and planetary health.5 

The ASA Subcommittee on Environmental Health and its website, a link for which is included at the end of this article, provides resources, references and inspiration for further study of sustainability in anesthesia.

This Earth Day, we hope you will join FAER in celebrating anesthesiology research that improves patient safety by considering the environment in every anesthetic decision.

ASA Subcommittee on Environmental Health Website: https://www.asahq.org/about-asa/governance-and-committees/asa-committees/committee-on-equipment-and-facilities/environmental-sustainability

More Information on FAER Grants: https://www.asahq.org/faer/researchandeducation

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