Critical Care - Theses

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    Decarbonising Healthcare
    McAlister, Scott Jeremy ( 2021)
    At COP26, thirty-six countries committed to develop low-carbon health systems, with a further fourteen countries setting a target of net-zero healthcare by 2050. There is currently little information available, however, on the carbon footprint of most healthcare activities, nor is there any recognised way for carbon emissions to be included in the clinical decision-making process. This research explores how healthcare can rapidly reduce its carbon footprint while not adversely effecting patient health. It does so in three parts: methodology, measurement, and mitigation. Methodology explores how to incorporate carbon footprints, calculated from environmental life cycle assessment (LCA), into health technology assessments (HTAs) including cost-effectiveness analysis and cost-benefit analysis, or as one criterion in a multi-criteria decision analysis. There are no technical impediments to stop the incorporation of carbon emissions into HTAs. Rather, the main barrier is that unlike other sectors of the economy, currently few LCAs have been undertaken in healthcare to quantify carbon emissions. Measurement examined the consequential and attributional life cycle carbon emissions of pathology blood tests (full blood examination, coagulation profile, urea and electrolytes, C-reactive protein, and arterial blood gases); the attributional life cycle carbon emissions of urinalysis; and the consequential and attributional life cycle carbon emissions of diagnostic imaging (magnetic resonance imaging (MRI), computerised tomography (CT), chest X-ray (CXR), mobile chest X-ray (MCXR), and ultrasound(US)). The consequential LCA of pathology testing showed the greatest source of carbon emissions originated from phlebotomy, which can be reduced by only ordering tests when necessary. The attributional LCA additionally showed the impacts of standby power usage, which can be reduced by moving to renewable energy and ensuring analysers are highly utilised. For diagnostic imaging for both attributional and consequential analysis, X-rays and US have lesser carbon emissions compared to MRI and CT, and therefore should be preferentially used wherever possible. The attributional LCA showed that MRIs and CTs have a carbon footprint similar to the known carbon hotspot of anaesthesia. These carbon emissions can be similarly reduced by moving to renewable energy and ensuring the high utilisation rates of scanners. Mitigation shows how an intervention to reduce unnecessary pathology testing by the Department of Medicine at St George Hospital, Sydney, led to 10% reduction in pathology tests over the six-month intervention period. The reduction resulted in a saving of 132kg carbon dioxide equivalent (CO2e) and A$53,573, with no change in adverse patient outcomes. The second part of Mitigation investigated the prevalence of unnecessary routine preoperative testing at Western Health. It found virtually no unnecessary testing, with the odds of potentially receiving an unnecessary preoperative test being 0.017. This thesis highlights that there are large research areas to be undertaken for healthcare to decarbonise, especially in performing LCAs of healthcare consumables, devices, and interventions. Additionally, the thesis shows that low-value care, such as the overutilisation of testing, should be an initial focus towards healthcare’s decarbonisation, as reducing low-value care reduces carbon emissions while not adversely effecting patient health.