Duke Health Sustainability Project

Abstract

The Duke Health Sustainability Masters Project focused on quantifying the environmental impact of the Duke University Health System (DUHS) and implementing sustainability initiatives to decarbonize and reduce waste within the hospital’s facilities. This work is imperative, given that 10% of greenhouse gas emissions in the United States come from the healthcare sector. The project’s first objective was to establish a baseline of DUHS’ emissions through greenhouse gas accounting. Once this work was completed, the team collaborated with various stakeholders to create roadmaps for implementation in the following areas.

1) Addressing the Global Warming Potential (GWP) of Anesthetic Gasses: The team worked alongside a team of anesthesiologists to identify which anesthetic gasses had the highest GWP and advocate for the transition to less harmful alternatives. 2) Greening the OR: The team supported the efforts of the Urology Department to identify waste streams throughout the operating room and mitigate waste. 3) Climate Change and Health Curriculum: to promote the understanding of climate change as a driver of poor health outcomes, the team collaborated with the Duke School of Nursing and Duke School of Medicine to advocate for the incorporation of environmental health into student’s curricula.

These efforts were made possible through the support of Sustainable Duke and Duke University Hospital leadership. The final deliverable focused on creating a sustainability report that highlights existing work in this space, key areas of interest, & opportunities for future directions.

Key findings include:

Emissions ● Duke University Hospital produced approximately 104,00 metric tons of carbon dioxide equivalent in fiscal year 2019. ● Scope 1 emissions constituted 26% of the hospital’s total emissions, scope 2 emissions constituted 40% of total emissions, and scope 3 emissions constituted 34% of total emissions. ● The largest contributor to the hospital’s scope 1 emissions was natural gas from on-campus operations. The largest contributor to the hospital’s scope 2 emissions was purchased electricity. The largest contributor to the hospital’s scope 3 emissions was emissions from staff and faculty commuting.

Waste ● 52.2 lbs of non-regulated medical waste were generated in the operating room following one procedure (laparoscopic nephroureterectomy). ● A lack of non-regulated medical waste bins in hallways outside of operating rooms resulted in significant amounts of non-hazardous waste being incinerated. ● Minimal recycling is handled at DUHS’s main hospital, with significant quantities of cardboard and plastic being sent directly to landfill or incineration.

Education ● While the Duke School of Nursing (DSON) has found ways to incorporate climate change into their curriculum, there are no formal avenues for education on environmental health topics at the Duke University School of Medicine (DUSOM). ○ There is student-driven interest at DUSOM in these course offerings.

Key recommendations include:

Emissions ● Duke University Hospital should track anesthetic gas usage. These gasses have a high global warming potential and are likely a large contributor to the hospital’s scope 1 emissions. The impact of these gasses was not included in our project, but our team recommends that the hospital investigate the usage and emissions impact of these gasses. ● Duke University Hospital should pursue scope 2 emissions reductions through energy efficiency measures or through encouraging Duke Energy to have less emissions intensive electricity. ● Duke University Hospital should track further scope 3 emissions subcategories to get a more comprehensive analysis of scope 3 emissions. Our team was able to track some, but not all, scope 3 emissions subcategories. Additionally, a recommendation is for Duke University Hospital to encourage employees to commute via methods that are less emissions intensive, as a large percentage of scope 3 emissions was from employee commuting.

Waste ● DUHS should invest in recycling infrastructure and develop a system for monitoring its various waste streams. ● DUHS should purchased environmentally preferred products when possible, to minimize overall environmental impact.

Education ● Duke University School of Medicine should integrate environmental health and climate curriculum into their first-year course, “Cultural Determinants and Health Disparities" and/or during the didactic lectures during rotations.