Carbon emissions and hospital pathology stewardship: a retrospective cohort analysis

Abstract

Background As healthcare is responsible for 7% of Australia's carbon emissions, it was recognised that a policy implemented at St George Hospital, Sydney, to reduce non‐urgent pathology testing to 2 days per week and, on other days only if essential, would also result in a reduction in carbon emissions. The aim of the study was to measure the impact of this intervention on pathology collections and associated carbon emissions and pathology costs. Aims To measure the impact of an intervention to reduce unnecessary testing on pathology collections and associated carbon emissions and pathology costs. Methods The difference in the number of pathology collections, carbon dioxide equivalents (CO2e) for five common blood tests and pathology cost per admission were compared between a 6‐month reference period and 6‐month intervention period. CO2e were estimated from published pathology CO2e impacts. Cost was derived from pathology billing records. Outcomes were modelled using multivariable negative binomial, generalised linear and logistic regression. Results In total, 24 585 pathology collections in 5695 patients were identified. In adjusted analysis, the rate of collections was lower during the intervention period (rate ratio 0.90; 95% confidence interval (CI), 0.86–0.95; P < 0.001). This resulted in a reduction of 53 g CO2e (95% CI, 24–83 g; P < 0.001) and $22 (95% CI, $9–$34; P = 0.001) in pathology fees per admission. The intervention was estimated to have saved 132 kg CO2e (95% CI, 59–205 kg) and $53 573 (95% CI, 22 076–85 096). Conclusions Reduction in unnecessary hospital pathology collections was associated with both carbon emission and cost savings. Pathology stewardship warrants further study as a potentially scalable, cost‐effective and incentivising pathway to lowering healthcare associated greenhouse gas emissions.

Planetary Health and Hospitals’ Contribution—A Scoping Review

“…The studies included both a quantitative and a qualitative methodical approach. None of the studies utilizing a purely qualitative approach, while 18 studies followed a full quantitative approach [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. Three studies applied a mix of quantitative and qualitative methods [ 49 , 50 , 51 ].…”

“…Of particular note are operating theatres, investigated in four studies [ 34 , 47 , 48 , 50 ]. Two studies analyzed GHG emissions in pathology [ 39 , 40 ], while two other studies focused on hospital kitchens and the associated meal menus for patients [ 42 , 43 ]. Other hospital-based departments included radiology [ 35 ], orthopedics [ 45 ], rehabilitation [ 31 ], intensive care unit [ 33 ] and neurology [ 32 ], with one study each.…”

“…In total, eight studies implemented climate actions. These used, inter alia, before/after models to illustrate the results of implementing their actions [ 31 , 32 , 36 , 37 , 39 , 44 , 45 , 46 ].…”

“…In total, four studies considered climate actions in the area of waste [ 36 , 37 , 39 , 46 ]. Three of these dealt with actions to reduce waste by switching from disposable containers (DSC) to reusable sharps containers (RSC).…”

“…Primary data, such as patient referral data, as well as secondary data from previous studies were used to calculate GHG emissions. The implementation of climate actions led to a reduction in GHG emissions [ 39 ].…”