Sustainable perioperative care
Many opportunities exist to address the resource intensity of perioperative care while ensuring and enhancing quality and safety.
CASCADES Contact
Community Practice
Teams across Canada are invited to join a Community of Practice for those working to implement sustainability projects in the perioperative care setting. At this monthly national check in, participants are invited to share their experiences and seek guidance on how to maximize the impact of their sustainability efforts.
CASCADES is hosting these check-ins in partnership with the Ontario Surgical Quality Improvement Network (ONSQIN) Surgical Quality Improvement Campaign Cut the Carbon: Reducing Surgical Waste. National check-ins take place the third Friday of each month.
Email Katy Devitt for info
Implementation resources for sustainable perioperative care practices
Sustainable Perioperative Care Playbook
A step-by-step guide to change ideas that address perioperative care in the Canadian context.
Explore sustainable perioperative care project charters
Appropriate pre-op visits and testing
- Estimating environmental impacts of unnecessary care (CASCADES)
- VIDEO: The Environmental Impacts of Unnecessary Blood Tests with Dr. Karina Spoyalo
- Drop the Pre-Op (Choosing Wisely Canada)
- Seven Tests and Treatments to Question (Choosing Wisely Canada)
- Project Green Healthcare (UofT Medicine - CW Team)
- Medical Imaging Equipment Study: Assessing Opportunities to Reduce Energy Consumption in the Healthcare Sector (Canadian Coalition for Green Healthcare)
Wise blood use
- Estimating environmental impacts of unnecessary care (CASCADES)
- Using Blood Wisely (Choosing Wisely Canada)
- Patient Blood Management (Sask Blood)
- Maximum Surgical Blood Ordering Schedule (MSBOS) (Government of Newfoundland and Labrador: Department of Health and Community Services Provincial Blood Coordinating Program)
Eliminate desflurane
- Project charter
- Volatile Anesthetic Gases Survey (Melissa Ho, NYGH)
- VIDEO: Eliminating Desflurane at NYGH with Dr. Melissa Ho
- VIDEO: Sustainable Anesthetic Practices with Dr. Anita Rao & Dr. Peter Menikefs
- Guidelines to the Practice of Anesthesia: Revised Edition 2023 (see Section 10: Guidelines for Environmental Sustainability; p. 20) (Canadian Anesthesiologists’ Society)
- Ontario’s Anesthesiologists Position Statement on Reporting Anesthetic Gases in the Ontario Hospitals Greenhouse Gas Inventory (OA)
- Ontario Hospitals That Have Banned Desflurane (PEACH)
- Reduce Your Contribution to Climate Change with Dr. Sanjiv Mathur (CCL)
- Mitigating the environmental impacts of anesthetic gases in healthcare (Alpamys Issanov, UBC Sustainability Scholar)
- ASA Green Anesthesia Speaker Session (March 24, 2022)
Use low flow anesthesia
Reduce nitrous oxide wastage
- Project charter
- Nitrous Oxide Briefing Note (Sunnybrook Team)
- Sunnybrook Nitrous Oxide Project Charter (Sunnybrook Team)
- Blank Sunnybrook Nitrous Oxide Charter (Sunnybrook Team)
- VIDEO: Reducing N₂O Wastage with the Sunnybrook team
- VIDEO: Nitrous Oxide Mitigation: Launching the UK and ROI National Audit (NHS)
- Piped Nitrous Oxide Waste Reduction Strategy (Chakera, Fennell-Wells & Allen)
- Nitrous Oxide Mitigation Implementation Plan (Health Finance, Corporate Governance & Value, Directorate, Scottish Government)
- Nitrous Oxide Project (NHS Association of Anaesthetists)
Reusable garment bags
- Project charter
- Implementation Guide for BYORB (NYGH + CASCADES)
- Implementation Guide for Other Reusables (NYGH + CASCADES)
- VIDEO: BYORB with Dr. David Smith
- VIDEO: BYORB with Dr. David Smith & team
Reusable gowns
- Project charter
- Reusable Gowns Briefing Note (CASCADES)
- The Ottawa Hospital Reusable Gowns Evaluation (TOH)
- VIDEO: Reusable Gowns with Angelina Lomoro
- A circular economy model for hospital generated PPE and medical single use plastic waste: Demonstrating opportunities for reduction and reuse (Canadian Coalition for Green Health Care)
- Implementation Module: Moving (Back) to Reusables in the OR (Practice Greenhealth)
- Sustainable Procurement Criteria - Reusable Textiles (Healthcare Without Harm Europe)
Reusable/extended breathing circuits
- Project charter
- Letter from vendor testifying to safety of extended use (Ali Abbass)
- VIDEO: Breathing Circuits with Dr. Melissa Ho
- Reusable Breathing Circuits: Background and information sheet (Ontario’s Anesthesiologists Environmental Sustainability Working Group)
Reusable LMAs
- Project charter
- Reusable LMA processing and documentation at Collingwood General
and Marine Hospital (CGMH) (Dave Ohrling, Becky Desroches, Shannon Foster and Jonalyn Andaya) - VIDEO: Reusable LMAs with Dr. Melissa Ho
- Reusable LMAs: Background and presentation (Ontario’s Anesthesiologists Environmental Sustainability Working Group)
Optimize custom packs
- Project charter
- VIDEO: Custom Pack Optimization with Cameron Irani
- Implementation Module: OR Kit Reformulation (Practice Greenhealth)
Device remanufacturing
- Project charter
- Stryker infographic (Stryker)
- VIDEO: Device Remanufacturing with Laurie Thomas
- VIDEO: Device Remanufacturing with Laura Donahoe
- Device Remanufacture "How To" Guide: Medical Devices (NHS)
Pharmaceutical waste
- Project charter
- St. Joe’s Pharma Waste Policy – DRAFT (St. Joe's)
- UHN waste Policy (UHN)
- VIDEO: Pharmaceutical Waste with Dr. Ali Abbass
- TRA2SH Sharps Audit Protocol Resource for Greening General Medical and Surgical Hospitals Pollution Prevention Information (City of Toronto, ChemTRAC 2010)
- Safe management of wastes from health-care activities: Second edition (WHO 2014)
- Performing Hospital Waste Audits (Waste Management Healthcare Solutions)
- Stewardship for Sharps and Reusable Sharps Containers (Global Product Stewardship Council)
Biomedical waste
- Project charter
- St. Michael's Hospital Biohazardous Waste Poster (St. Mike's)
- VIDEO: Waste Segregation with Ali Abbass
- VIDEO: Follow the Waste with Ali Abbass
- Safe management of wastes from health-care activities: Second edition (WHO 2014)
- Daniels Biomedical Waste Poster
- Performing Hospital Waste Audits (Waste Management Healthcare Solutions)
Plastic waste
- Project charter
- Managing Non-Cytotoxic IV/Fluid Line & Bag Waste (Ali Abbass)
- VIDEO: PVC 123 Recycling Program with Dr. Ali Abbass
- VIDEO: OR Recycling at UHN with Ed Rubenstein
- Clinical Recycling Trainer Program Guide (BC GreenCare)
- Performing Hospital Waste Audits (Waste Management Healthcare Solutions)
- PVC 123 Program Details (The Vinyl Institute of Canada)
- PVC Recycling Vinyl Council of Australia Recycling Streams in Theatre (Green Theatres Network)
Sustainable Perioperative Care Scorecard
The Scorecard is an assessment tool designed to help perioperative care teams to understand and visualize their progress towards environmental sustainability. It offers an important starting point to identify and capitalize on change opportunities to improve perioperative care.
This scorecard is currently being piloted at sites across Canada.
Implementation resources
Scorecard results
Share the areas of focus at your site and feedback on the scorecard by completing this survey.
Some of these responses will be used to populate the Scorecard Dashboard to showcase all the great work sites are doing across Canada to improve the sustainability and environmental impact of perioperative care.
Join the community of practice
Teams across Canada using the Sustainable Perioperative Care scorecard are invited to join a national check-in hosted the third Friday of each month by CASCADES and ONSQIN.
Participants are invited to share their experiences and use this opportunity to seek guidance on how to maximize the impact of their sustainability efforts. Please email Katy Devitt for more information.
Regional Anesthesia in Breast Surgery Playbook
A step-by-step guide on regional anesthesia in breast surgery
More resources on sustainable perioperative care
- Greening the OR: Canadian Anesthesiologists’ Society Position Statement on Reducing Harmful Emissions, Waste and Costs ->
- Canadian Anesthesiologists’ Society (CAS) Background Paper for the CAS Position Statement on reducing harmful emissions, waste and costs ->
- Anesthetic gases primer ->
- Anesthetic gases infographic ->
- Anesthetic Gas at Raigmore Hospital, within NHS Highland (UK) ->
- Operating room primer ->
- Operating room infographic ->
- Red Bag Initiative, Carolinas Medical Centre (Charlotte, North Carolina) ->
We want to hear from you
Materials created by CASCADES are shared under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Public License (CC BY-NC-SA 4.0).
While it is not a requirement under the license, we would be grateful if you would let us know where and how you use, share or adapt our materials.
Other action areas
Care pathways
Key actions can minimize the environmental harms of medications throughout their lifecycle and address increased medication-related risks due to climate change.
Many opportunities exist to address the resource intensity of perioperative care while ensuring and promoting high quality care.
Comprehensive person-centered primary and community care can support health and wellbeing and reduce the need for more resource intensive services.
Practitioners across specialties can take meaningful steps to reduce the environmental impacts of their practice and safeguard patient and population health.
Health services can promote health, including by delivering healthy food, effective chronic disease management, and climate-adapted clinical care.
System enablers
Sustainability is intrinsically linked with both quality care and patient safety and can be embedded within these efforts.
Leadership and good governance are needed to develop and deliver effective climate and sustainability strategy.
The shift to climate resilient and sustainable health systems requires accurate assessment of healthcare’s environmental impacts.
Health systems can leverage their purchasing power to influence vendors and shape markets for sustainable and resilient health sector products and services.
Healthy food, digital innovation and effective waste management are among the key enablers of low-carbon, sustainable and climate-resilient health systems.