Opinion | How health systems can fight climate change by not using desflurane

Opinion | How health systems can fight climate change by not using desflurane

Physicians, nurses and other front-line providers know firsthand the health impacts of climate change. Air pollution exacerbates asthma and emphysema; extreme heat worsens heart and kidney conditions; and rising temperatures increase the occurrence of a wide range of illnesses, including mosquito-borne infections and depression.

That’s why it’s so shocking to learn that health care itself is a major contributor to climate change.

In the United States, the health sector is responsible for nearly 9 percent of the nation’s greenhouse gases. Researchers estimate that the environmental harm caused by medical care ultimately costs as many lives as preventable medical errors, which are responsible for as many as 98,000 deaths annually. This is in direct conflict with the mission of the healing professions.

Brian Chesebro, an Oregon-based anesthesiologist who serves as medical director of environmental stewardship at Providence, had this “aha” moment in 2016. At the time, he told me, he was going through a period of “eco-grief” about the state of the Earth.

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“Instead of spiraling down, I realized that my greatest opportunity to advance environmental stewardship was through my job as a physician,” he said. “I could address it in my own practice, then, as a physician-leader in my hospital, inspire change in my colleagues.”

His work as an anesthesiologist turned out to be the right launchpad. That is because some anesthetic gases commonly used in operating rooms are extremely potent greenhouse gases.

As Emily Mediate from the nonprofit organization Health Care Without Harm told me, the elimination of one specific gas, desflurane, could make a profound impact. “Desflurane has the global warming potential of over 3,700 equivalents of carbon dioxide,” she told me. “It lasts for 14 years in the atmosphere.” Her organization is among those that have been urging health-care systems to move away from desflurane and switch to sevoflurane and isoflurane, anesthetics that are clinically equivalent but have a small fraction of the environmental consequence of desflurane.

Chesebro took on this challenge. He began by educating fellow clinicians. “We weren’t taught to think in terms of environmental impact in residency,” he said, noting that the response from other physicians was primarily “surprise, interest and curiosity.”

He also measured and documented each anesthesiologist’s desflurane use. When Chesebro informed a colleague that his use of desflurane was equivalent to driving a fleet of 12 Hummers, the colleague sputtered in defense, “But I drive a Prius!”

“He was trying so hard to make wise stewardship choices, but he didn’t realize that his environmental impact as an anesthesiologist far outstripped any other facet of his life,” Chesebro said. “He changed his practice that day and has never used desflurane since.”

Over time, Chesebro redesigned systems so that desflurane was less easily accessible than other inhaled gases. “We still keep one or two desflurane vaporizers so someone could use it if they really need it, but it is no longer at arm’s reach in every operating room,” he said. He believes this was more effective than banning the gas. “Instead creating adversaries, we created an army of advocates who are eager to partner with us” on other efforts.

Before this intervention, the Providence system’s eight Oregon hospitals used desflurane 42 percent of the time, according to Chesebro. Now, he says, the rate is 0.07 percent. “We’ve cut emissions related to anesthetic use by 95 percent, and, because desflurane is a more expensive option, we’ve also cut the financial cost by 80 percent.”

Providence is not alone. Mediate shared success stories from around the country. Virginia Mason Medical Center eliminated desflurane use, thanks to the advocacy of an anesthesiologist and an anesthesia tech there. This resulted in an estimated 60 percent decrease annually in its operating room greenhouse emissions and saved the hospital more than $30,000 each year. Advocate Aurora Health, in a nurse-led effort, also cut its use of desflurane. Since 2017, the health system has reduced its anesthetic gas emissions by 75 percent and saved $1.6 million.

There is still a lot more work to be done. While the U.S. health system accounts for about a quarter of all global health sector-related emissions, it is far behind many peer countries in tackling this problem. In fact, many political leaders are actively trying to block sustainability initiatives.

I was heartened to learn that Health Care Without Harm’s Climate Council includes 21 health systems representing more than 600 hospitals across 43 states. In addition to health sector-specific reforms, they are encouraging others to join them in addressing building emissions, switching to renewable energy and limiting single-use plastics, among other efforts to reduce their carbon footprint.

“Health-system leaders understand that the climate crisis is a health crisis,” Mediate said. “Better care is low-carbon care.”

That’s a perspective on medical care that I wasn’t aware of before. Now, I’m convinced that clinicians’ obligation to “first do no harm” should extend to our responsibility to reduce the effects of climate change caused by the health-care sector itself.