Certified Sustainability: How Hospitals Can Set and Meet Anesthetic Gas Waste Benchmarks

Why get certified?

As described on TJC’s website,³ certification in sustainability can help hospitals reduce environmental impact, enhance reputation, and improve health outcomes for patients, staff and the community.

Through energy-efficient practices, hospitals can achieve operational efficiencies that result in cost reductions. They may also “qualify for tax incentives to finance climate resiliency and renewable energy infrastructure projects.”

Additionally, “sustainability practices can help mitigate environmental, societal, and financial risks, ensuring that hospitals are prepared to adapt to changing regulatory landscapes and potential disruptions.”

Who is eligible for certification?

Voluntary Sustainable Healthcare Certification is open to any hospital or critical access hospital that meets the following requirements:³

• The organization must be in the U.S., operated by the U.S. government, or operated under a charter of the U.S. Congress
• The organization is a hospital or critical access hospital that is compliant with applicable federal laws, including applicable Medicare Conditions of Participation
• At the time of review, the organization needs to have baseline emissions data for three GHG emission sources and an action plan to reduce
• At the time of recertification, the organization needs to have 24 months of data and demonstrate a reduction of three GHG emission sources

Why target inhaled anesthetics?

Anesthetic gas use, including volatile agents and nitrous oxide, is one of the six GHG emission sources TJC considers for certification. The others are as follows:³

• Energy use (fuel combustion)
• Purchased electricity (purchased grid electricity, district steam, chilled and hot water)
• Pressurized metered-dose inhaler use
• Fleet vehicle carbon-based fuel use (from organization owned vehicles)
• Waste disposal

In high-income countries, including the U.S., inhaled anesthetic gases released directly into the atmosphere are estimated to contribute 5% of acute hospital CO₂e emissions and 50% of perioperative department emissions.³ The anesthetics desflurane and nitrous oxide contribute the most emissions out of the major medical GHGs, equivalent to driving 12 million gasoline-powered cars annually in the U.S.⁴

While inhaled anesthetics are a significant source of harmful healthcare emissions, there are practices hospitals can implement and supporting technologies they can deploy to help reduce their impact. 

In its Action guidance for addressing pollution from inhalational anaesthetics, the Association of Anaesthetists recommends hospitals “avoid inhaled anesthetics with disproportionately high climate impacts, such as desflurane and nitrous oxide,” and select “the lowest possible fresh gas flow” when using inhaled anesthetics.⁵

With regards to the latter, there are anesthesia machines available to hospitals today that are designed to help facilitate the use of low- and minimal-flow anesthesia and the recirculation of sample gas. The benefits of this approach may go beyond sustainability. Low- and minimal-flow anesthesia delivery techniques are associated with lower costs and can offer clinically relevant benefits.⁶

How can my hospital access data on anesthetic gas usage?

As noted previously, there are two data sets TJC requires a hospital to provide for Sustainable Healthcare Certification: 

1. During the review process, baseline emissions data for the three GHG emission sources they are targeting to reduce
2. For recertification, 24 months of data and demonstration of a reduction of three GHG emission sources

Additionally, TJC requires certified organizations to convert greenhouse gas measurements to metric tons of carbon dioxide equivalents (MTCO2e).

Digital transformation of hospital processes and the leveraging of data for actionable analytics has increased in recent years, with hospital executives prioritizing investments in enabling technologies.⁷ When it comes to analytics on anesthetic gas usage, perioperative teams and anesthesia providers might question where this data exists in their infrastructures and how they can access it.

With increased recognition for the impact of anesthetic agent usage on a hospital’s costs, patient care quality, and environmental footprint, applications have emerged that provide gas consumption analytics for networked anesthesia machines.

A hospital can meet TJC requirements for its Sustainable Healthcare Certification by leveraging gas consumption analytics to:

• Gain transparency on inhaled anesthetic gas consumption, uptake, efficiency, cost, and applied fresh gas flows
• Analyze the usage of desflurane, nitrous oxide, sevoflurane, and isoflurane 
• Visualize the CO2 equivalent of each wasted anesthetic agent
• Review performance and improvements in anesthetic and gas use reduction with indicators such as efficiency (uptake vs consumption), cost per case, total cost, and fresh gas flows used
• Filter the data by selecting single operating rooms (OR) or cases, case durations, and specific time frames
• For individual reporting purposes or subsequent analysis, the collected data can be exported into a spreadsheet

Conclusion

As evidenced by TJC’s Sustainable Healthcare Certification initiative and the Association of Anaesthetists’ published guidance, reducing anesthetic gas waste is a core component of U.S. hospitals’ sustainability efforts, aligning with broader goals to help minimize healthcare’s environmental footprint.^3,5

TJC’s certification provides a structured path for hospitals to measure, report and reduce GHG emissions, reinforcing their commitment to responsible healthcare practices. Gas consumption analytics for networked anesthesia machines can serve as a valuable tool for helping hospitals meet sustainability benchmarks and drive meaningful change.³