Reducing low-value care is another way to eliminate carbon-producing activities associated with unnecessary scans, testing and procedures. This has been a priority for U-M, thanks to the Michigan Program on Value Enhancement — a collaboration of Michigan Medicine and the University of Michigan Institute for Healthcare Policy that aims to improve the quality of care at the institution — and a partnership with the similarly oriented Michigan Value Collaborative, also referred to as MVC, a collaborative quality initiative that serves the entire state.
Last year, the two organizations collaborated on a study that highlighted how much routine testing was still done before surgeries despite its low value. Berlin was the first author. “U-M is considered one of the leading institutions studying low-value care and efforts to limit that type of care,” Berlin said. “But like a lot of other centers, we are really just at the precipice of these initiatives. I would anticipate big changes in the next 10 years.”
Some sustainability shifts may come even sooner at Michigan Medicine. For instance, the Department of Anesthesiology recently launched the Green Anesthesia Initiative, or GAIA for short. Its mission: become more environmentally conscious about the types and rates of anesthesia its providers use, another area Agbafe and Berlin say is ripe for improvement.
“This is a topic of fairly intense discussion right now in the field, and I’ve been thinking about it for a while,” said George Mashour, M.D., Ph.D., the chair of the Department of Anesthesiology and the Robert B. Sweet Professor of Anesthesiology at the University of Michigan Medical School. “Unlike other industries, I don’t think that we require massive disruption in order to make progress because, fortunately, we have options.”
Several inhaled gases regularly used for anesthesia are A-list offenders when it comes to greenhouse gas production. Nitrous oxide, commonly known as laughing gas, is a greenhouse gas, a direct ozone depleter and does not dissipate from the atmosphere for more than a century after it’s produced.
However, the inhaled anesthetic sevoflurane has much less of an environmental impact than nitrous oxide and other common inhaled agents, so Mashour says it would be a good alternative.
“The overall goal is to shift away from some of these egregious culprits and start making better choices about which drug we use and then also how we use it,” Mashour said. “The contributions in terms of greenhouse gas effect or ozone-depleting action partly relate to how much is getting pumped out into the atmosphere and that relates directly to how high we have our fresh gas flow,” he added. “If we have, for example, 10 liters going, we’re blowing a lot of anesthetic into the scavenging and waste and atmospheric systems that doesn’t need to be there.”
To that end, Mashour’s colleagues in the Department of Anesthesiology are already leading a national initiative to try to reduce anesthetic gas flow rates through the Multicenter Perioperative Outcomes Group, another quality initiative that includes health centers from across the country.
Mashour plans to roll out other elements of GAIA over a three- to- five-year period. “We could be doing better,” he said. “Right now, we’re starting the conversations, getting people on board and making structural choices in the department to help make it easy for people to do the right thing.”
Source: Michigan Medicine – University of Michigan
Source: Healthcare in Europe
