The Joule Innovation grant program offered funding, professional support and mentorship to physicians and medical learners making a difference in health care. This is part of a series of stories about the 2020 recipients and their innovations.
When Dr. Simon Berthelot started developing an app to teach hospitals how to reduce their ecological footprint, he never imagined the tsunami of trash the COVID-19 pandemic would produce.
In the last year, the massive amount of personal protective equipment (PPE) required during the pandemic has become a major source of environmental pollution in the health care system, with millions of nitrile gloves, polyethylene aprons, plastic face shields and polypropylene surgical masks being manufactured, used and disposed of.
“It’s critical to protect health care workers during the pandemic,” says Dr. Berthelot, “but we need to do this while avoiding other negatives consequences on human health. Performing a life cycle assessment on PPE is an effective tool to reduce that waste.”
Adapting life cycle assessments to health care
Life cycle assessment (LCA) has been used for decades to gauge the environmental impact of a consumer product — from the extraction of raw material, through the production, transportation, use and disposal of the item.
An emergency medicine specialist and researcher at CHU de Québec – Université Laval, Dr. Berthelot was interested in applying the same methodology to the products and services in the health care system. He assembled a team of experts with knowledge of LCAs to help with the adaptation and to produce the Med-LCA app.
The team completed its first health care–related LCA last summer. It found that in the investigation of a pulmonary embolism, a lung ventilation/perfusion scan is twice as polluting as a chest CT angiogram, largely because two different machines are required to perform the scan rather than one.
“Life cycle assessments let us identify critical points where we can reduce our environmental impact in health care systems, reduce unnecessary activities and improve processes that really benefit patients.”
— Dr. Simon Berthelot, creator of Med-LCA
Helping reduce emissions from Canada’s health care system
In 2019, The Lancet Countdown on health and climate change found that Canada’s health care sector accounts for approximately 4% of the country’s total greenhouse gas (GHG) emissions. When compared with health care systems in 47 countries, Canada has the third-highest per capita emissions. The data also indicated that most of that pollution is generated by hospitals — high-energy-use facilities that produce massive amounts of waste, including single-use products.
The goal of Med-LCA is to help reverse this trend by giving hospitals the tools to carry out their own LCAs. With the support of Dr. Berthelot and his team, health system managers will be able to use the app to analyze the ecological footprint of each health care activity, take steps to reduce or eliminate the most polluting ones and choose more eco-friendly options.
“Overuse and misuse within our health care system have significant environmental impacts and our actions must now aim for greater ecological efficiency,” says Dr. Berthelot. “A paradigm shift is needed, and it will fall on managers and clinicians alike to step up.”
A step-by-step guide to sustainability
With his $30,000 Joule Innovation grant, Dr. Berthelot and his team plan to complete the LCAs necessary to establish a representative sample of the care activities performed in the health care system. In the next six months they plan to analyze:
- anesthetic gases such as sevoflurane versus alternatives;
- imaging techniques such as lumbar spine MRIs and chest x-rays; and
- waste management options for PPE.
They also plan to analyze patient care pathways and compare the environmental impact of consultations by telemedicine versus in-person care.
From these assessments, Dr. Berthelot will develop a how-to-guide for all stakeholders in the health care system who want to perform a LCA, with an ultimate goal of designing the Med-LCA prototype app so health care managers can adapt it to the specific activities in their hospitals.
“We hope life cycle assessment becomes firmly entrenched in the health care system and makes a tangible difference in terms of its sustainability,” he says.
The 2020 Joule Innovation grant program provided $500,000 to support physician-led innovations in the areas of sustainable health care, physician health and wellness, health care solutions and access to care.