Developing a quality improvement project to tackle the desflurane problem

Area of Science:

• Environmental Science
• Anesthesiology
• Healthcare Sustainability

Background:

• Volatile anesthetic agents, commonly used in anesthesia, are potent greenhouse gases.
• Desflurane has a particularly high global warming potential, prompting global efforts to reduce its use.
• Deeply entrenched practices in a Singaporean tertiary teaching hospital favored desflurane for high operating theatre turnover.

Purpose of the Study:

• To reduce desflurane usage by 50% (by volume) within 6 months.
• To decrease the number of operating theatre cases using desflurane by 50% within 6 months.
• To promote a cultural shift towards responsible anesthetic agent selection.

Main Methods:

• Collected baseline data on monthly desflurane usage.
• Implemented sequential quality improvement methods, including staff education and misconception correction.
• Utilized Plan-Do-Study-Act cycles for iterative improvement and sustained change.

Main Results:

• Achieved a 61.3% reduction in monthly median desflurane usage (from 31.5 L to 12.2 L).
• Reduced the number of theatre cases using desflurane by approximately 80%.
• Resulted in annual cost savings of US$195,000 and over 840 tonnes of CO2 equivalents saved.

Conclusions:

• A multifaceted quality improvement project can significantly reduce the use of high global warming potential anesthetic agents.
• Anaesthetists can play a crucial role in mitigating healthcare's carbon footprint through responsible resource management.
• Sustained institutional change is achievable through persistent, evidence-based quality improvement initiatives.