Implementing a Green ICU Pathway Across a Large U.S. Health System: An Observational Study

Area of Science:

• Environmental Health
• Healthcare Management
• Sustainable Practices

Background:

• Intensive Care Units (ICUs) have a substantial environmental impact.
• Limited practical solutions exist for implementing sustainable practices in ICUs.
• There is a need for actionable strategies to reduce the environmental footprint of critical care.

Purpose of the Study:

• To describe the implementation of a systemwide Green ICU initiative.
• To utilize a previously established sustainability pathway for guidance.
• To report early outcomes and lessons learned from the initiative.

Main Methods:

• An observational study was conducted across a large, multihospital U.S. healthcare system.
• A sustainability infrastructure was built through partnerships (clinicians, sustainability office, supply chain, workgroups).
• Pilot projects focused on 'reduce, rethink, recycle'; emissions calculated using standardized protocols; LLMs used for procurement categorization.

Main Results:

• Transitioning to on-demand IV medication preparation reduced waste from 4.8% to 1.4%.
• Reduced unnecessary supplies diverted an estimated 3401 metric tons of CO2 equivalent annually.
• A saline flush recycling program collected over 1600 lbs of material in its first year.

Conclusions:

• Operationalizing a Green ICU pathway is feasible and yields environmental and financial benefits.
• Strong partnerships, structured processes, and adaptable metrics are crucial for scaling sustainability.
• This study provides an implementation roadmap for advancing Green ICU initiatives in healthcare.