Sustainable perioperative care
Many opportunities exist to address the resource intensity of perioperative care while ensuring and enhancing quality and safety.
Community of 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 infoHow to get started with sustainable perioperative care
Use these resources to take action, measure progress, and collaborate across your perioperative team.
Sustainable Perioperative Care Playbook
A step-by-step guide to change ideas that address perioperative care in the Canadian context.
Read Playbook >Project Charter Templates
Kickstart improvement projects with ready-to-use planning templates.
Explore Templates and Resources >Scorecard Dashboard
Track your progress and identify opportunities to improve sustainability.
Sustainable Perioperative Care Project Charters and Resources
Project charters are grouped by four sustainability principles and can be explored using the tabs below.
Avoid Unnecessary Care
Avoiding care that does not improve patient outcomes reduces emissions, waste, and unnecessary use of healthcare resources. This includes re-evaluating pre-operative testing and optimizing blood use.
Appropriate Pre-Operative Visits and Testing
Unnecessary pre-operative visits, tests, and imaging contribute to avoidable emissions and system inefficiencies. Evidence-based pre-operative assessment supports both patient safety and environmental sustainability.
Wise Blood Use
Optimizing blood use reduces unnecessary transfusions, conserves a valuable resource, and lowers the environmental footprint of perioperative care.
Minimize Direct Emissions
Direct emissions in perioperative care largely stem from anesthetic gases and energy use. This section focuses on reducing high-impact emissions through changes in anesthetic practice.
Eliminate Desflurane
Desflurane is a high-global-warming-potential anesthetic gas. Eliminating its use significantly reduces perioperative emissions without compromising patient care.
Use Low-Flow Anesthesia
Low-flow anesthesia reduces anesthetic gas consumption while maintaining safe and effective care.
Reduce Nitrous Oxide (N₂O) Wastage
Nitrous oxide is a potent greenhouse gas. Reducing wastage through system changes and monitoring can significantly lower emissions.
Substitute Reusable Alternatives
Replacing single-use products with safe, effective reusable alternatives reduces waste and emissions while supporting a circular healthcare economy.
Reusable Garment Bags (BYORB)
Reusable garment bags reduce single-use plastic waste associated with perioperative attire.
Reusable Gowns
Reusable surgical gowns reduce waste and can support cost savings and supply chain resilience.
Reusable / Extended Breathing Circuits
Extended and reusable breathing circuits can safely reduce single-use plastic waste in anesthesia.
Reusable Laryngeal Mask Airways (LMAs)
Reusable LMAs reduce waste while maintaining safety when proper reprocessing protocols are followed.
Reduce & Manage Waste
Improving waste segregation, reducing over-packaging, and supporting remanufacturing are key strategies for minimizing perioperative waste.
Optimize Custom Packs
Optimizing surgical packs reduces unused supplies and unnecessary waste.
Optimizing Surgical Trays
Optimizing surgical trays reduces unused instruments, lowers sterilization costs, and minimizes waste in perioperative settings.
Device Remanufacturing
Device remanufacturing extends the life of medical devices and reduces material and energy consumption.
Pharmaceutical Waste
Proper pharmaceutical waste segregation and policy alignment reduce environmental harm and regulatory risk.
Biomedical Waste
Improving biomedical waste segregation reduces disposal costs and environmental impact.
Plastic Waste
Targeted plastic recycling and segregation programs reduce landfill and incineration of perioperative plastics.
External Resources & Further Reading
- 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
- Operating Room Primer
- Operating Room Infographic
- Anesthetic Gas at Raigmore Hospital (UK)
- Red Bag Initiative (Carolinas Medical Centre)
- Regional Anesthesia in Breast Surgery Playbook
Scorecard supporting resources
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