Empowering Sustainability During Kidney Transplants Using a Patient Safety Framework

Healthcare-related emissions constitute 7.9% of total greenhouse gases, with a significant portion from operating rooms (ORs). As emissions negatively affect patient health, sustainability should be reframed as a critical element of patient safety. This study introduces alternative practices minimizing sterile blue towel and positioning foam use by integrating sustainability into the postoperative debrief, leveraging the entrenched patient safety framework.

An education session informed surgical staff of connections between OR emissions and patient safety, and alternative practices reducing blue towel and foam use. Sustainability was added to the postoperative debrief for kidney transplants; issues raised were transcribed into the electronic health record (EHR). Pre- and postintervention blue towel and foam use was audited. One year later, staff were surveyed regarding retention of sustainability-focused practices.

Forty kidney transplants (20 before and 20 after) were audited. 34.8% fewer blue towels (31.30 vs. 20.40, p = 0.0001) and 67.7% fewer foam pieces (2.35 vs. 0.76, p = 0.0001) were used. Concerns raised during the postoperative debrief were transcribed in 60.0% of cases. Importantly, one year later, 100.0% of surveyed staff agreed that they continue sustainable practices from the education session, and 75.0% agreed that staff discuss sustainability more than before.

Achieving systemwide change toward OR sustainability has been elusive. This is the first description of incorporating sustainability into the patient safety framework. The authors witnessed engagement from all surgical team levels and reductions in blue towel and foam use during kidney transplants. Expanding this practice to other procedures is a tangible pathway to sustainability goals.