Developing a quality improvement project to tackle the desflurane problem

被引:5
作者
Ang, King Sin [1 ]
Low, Zhao Kai [1 ]
Ng, Bryan Su Wei [1 ]
Poh, Pei Kee [1 ]
机构
[1] Natl Univ Singapore Hosp, Dept Anaesthesia, Singapore, Singapore
基金
英国科研创新办公室;
关键词
anaesthesia; quality improvement; PDSA; SEVOFLURANE; METAANALYSIS; ANESTHESIA; RECOVERY;
D O I
10.1136/bmjoq-2022-002132
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Anaesthesia is associated with the routine use of volatile anaesthetic agents, all of which are potent greenhouse gases in varying degrees. Desflurane, in particular, has a high global warming potential and in recent years, there has been a global movement to reduce or remove its usage entirely from operating theatres. We work in a large tertiary teaching hospital in Singapore with deeply entrenched practices of using desflurane to facilitate high turnover of operating theatre cases. We launched a quality improvement project to (1) reduce the median usage of desflurane by 50% (by volume), and (2) reduce the number of theatre cases administering desflurane by 50% over a period of 6 months.We collected baseline data to determine departmental monthly median usage of desflurane. We then deployed sequential quality improvement methods to educate staff and to eliminate misconceptions, as well as to promote a gradual cultural change.We successfully reduced monthly median desflurane usage from 31.5 L to 12.2 L per month (61.3% reduction) within our targeted time frame. We also achieved a reduction in the number of theatre cases using desflurane by approximately 80%. This translated to significant cost savings of US$195 000 per year and over 840 tonnes of carbon dioxide equivalents saved.Healthcare is a resource intensive industry. Anaesthetists are well placed to play an important role in reducing healthcare-related carbon emissions by choosing anaesthetic techniques and resources responsibly. Through multiple Plan-Do-Study-Act cycles and a persistent, multifaceted campaign, we achieved a sustained change in our institution.
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页数:6
相关论文
共 16 条
[1]   Impact of short-acting vs. standard anaesthetic agents on obstructive sleep apnoea: a randomised, controlled, triple-blind trial [J].
Albrecht, E. ;
Bayon, V. ;
Hirotsu, C. ;
Heinzer, R. .
ANAESTHESIA, 2021, 76 (01) :45-53
[2]  
Axelrod D., 2014, Greening the Operating Room and Perioperative Arena
[3]   A comparative study of desflurane versus sevoflurane in obese patients: Effect on recovery profile [J].
Bansal, Tania ;
Garg, Kamakshi ;
Katyal, Sunil ;
Sood, Dinesh ;
Grewal, Anju ;
Kumar, Arvind .
JOURNAL OF ANAESTHESIOLOGY CLINICAL PHARMACOLOGY, 2020, 36 (04) :541-545
[4]   Action guidance for addressing pollution from inhalational anaesthetics [J].
Devlin-Hegedus, J. A. ;
McGain, F. ;
Harris, R. D. ;
Sherman, J. D. .
ANAESTHESIA, 2022, 77 (09) :1023-1029
[5]  
Dodge I, 2021, NET ZERO NHS JUNE 20
[6]  
Gandhi J, 2022, DESFLURANE REDUCTION
[7]   The carbon footprint of general anaesthetics: A case study in the UK [J].
Hu, Xiaocheng ;
Pierce, J. M. Tom ;
Taylor, Tim ;
Morrissey, Karyn .
RESOURCES CONSERVATION AND RECYCLING, 2021, 167
[8]   DESFLURANE AND SEVOFLURANE - INHALATION ANESTHETICS FOR THIS DECADE [J].
JONES, RM .
BRITISH JOURNAL OF ANAESTHESIA, 1990, 65 (04) :527-536
[9]   Meta-analysis of trial comparing postoperative recovery after anesthesia with sevoflurane or desflurane [J].
Macario, A ;
Dexter, F ;
Lubarsky, D .
AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY, 2005, 62 (01) :63-68
[10]   Why be sustainable? The Australian and New Zealand College of Anaesthetists Professional Document PS64: Statement on Environmental Sustainability in Anaesthesia and Pain Medicine Practice and its accompanying background paper [J].
McGain, Forbes ;
Ma, Scott C. Y. ;
Burrell, Rob H. ;
Percival, Vanessa G. ;
Roessler, Peter ;
Weatherall, Andrew D. ;
Weber, Ingo A. ;
Kayak, Eugenie A. .
ANAESTHESIA AND INTENSIVE CARE, 2019, 47 (05) :413-422