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A New Measure of Patient Safety: Health System Sustainability

A patient arrives at the hospital with diabetic ketoacidosis and begins taking intravenous fluids and insulin. But the medical team accidentally administers twice as much insulin. When a drug is administered incorrectly, there is no doubt that it is a patient safety event.

Likewise, the care we provide is a strong contributor to the climate crisis, which is negatively affecting people’s health – shouldn’t this also be considered a patient safety event? With the healthcare sector accounting for 8.5% of US greenhouse gas emissions, we need to broaden the scope of what it means to protect patients.

The impact of climate change on patient safety

The patient safety movement, embodied in the phrase “First do no harm,“focused on one patient, one action. Founding articles in the 1990s catapulted patient safety to national attention, when it was estimated that up to 98,000 Americans could die each year due to preventable harm from medical errors. Since then, tireless efforts have been devoted to making healthcare systems safer – from establishing root case analyzes when an error occurs, to adopting a systems approach that considers all the intersecting factors allowing to an error in reaching the patient. Organizations such as The Mixed Commission (TJC), which evaluates and accredits American health programs, and To go pasta non-profit organization that promotes transparency in healthcare, were created, along with many othersas watchdogs to protect patients.

For too long, patient safety has only been seen as an issue in hospital hallways. But the fact is that the vast majority of factors that affect our residents occur outside these walls. the social determinants of health they are estimated to lead to 80% of patient health outcomes, while the treatments that we doctors administer only account for 20%. While we’d like to think our years of training and vast medical knowledge have more of an impact, the greatest health effects are beyond our control.

Climate change has an outsized impact on health – it can be seen as a risk amplifier. Not only is it a risk factor in itself, but it also increases health disparities and inequalities across the continuum. Estimates suggest that pollution, particularly from fossil fuels, has led to an estimated global total of 10.2 million (or 1 out of 5) premature deaths annually.

In addition to nearly 9% of total U.S. greenhouse gas emissions, our healthcare systems contribute more than 4 billion pounds of waste. The downstream effects of pollution, medical waste, excessive energy expenditure, anesthetic gases, etc., directly lead to climatic effects on the patients we are supposed to treat. An estimated 500,000 lung cancer deaths and 1.6 million chronic obstructive pulmonary disease deaths can be attributed to Pollution, which includes very small particles that pass from the lungs into the bloodstream and cause inflammation. The researchers suggest that pollution may also be responsible for 19% of all cardiovascular deaths and 21% of all stroke deaths. We increasingly see the many ways in which health is impacted by climate change, from heart disease to respiratory conditions, from cognitive changes to cancer, from mental health issues to vector-borne diseases. The most vulnerable, including children, the elderly, pregnant women and the economically disadvantaged, are disproportionately impacted. Children see increased rates of asthma and behavioral and cognitive effects, just to note a few. Older people may suffer more from cumulative impacts pollution on cancer, heart diseaseand even Alzheimer’s dementia. Exposure of pregnant women can lead to stillbirths and low birth weight.

It’s time for more action in the health sector

Groups such as Safe health care, Practice green healthand my green doctor recognize that the health sector has a responsibility to care for our patients and, first, to do no harm. These national organizations and others are working within the health sector to implement sustainable and energy efficient practices. There is no lack of potential targets. Operating rooms consume a lot of energy – but it is possible to adjust temperatures, lighting and air filtration when not in use. Many inhaled anesthetics are potent greenhouse gases, but can be safely replaced by less harmful anesthetics. Single-use PPE has exploded with COVID-19 – but reusable gowns and padding may supplant disposable plastic gear. Alcohol-based hand sanitizers can reduce water consumption. Non-toxic cleaners and pesticides should be used. Even the landscaping, construction and furnishings of healthcare facilities come into play.

None of these alternatives are required or systematically promoted. Although many sustainability initiatives pay dividends, they often require up-front capital and committed leadership which, in the face of numerous expenses and competing agendas, often pushes sustainability proposals to the bottom of the list. However, if sustainable practices were prioritized and there was a clear line of sight to the health impacts of climate change and pollution, such that it became a patient safety issue, health systems at across the United States could lead the way in sustainability.

There is also a financial incentive: preventing the disease is much more cost-effective than treating the disease. Pollution is estimated at more than $820 billion every year. These impacts are linked to premature deaths, hospitalizations, serious injuries, mental health disorders, lost wages, missed school and work days and other health problems. Healthcare systems can directly benefit from healthier populations as they would likely have shorter lengths of stay and fewer readmissions – all important considerations for hospitals.

It’s time to recognize that patient safety is not just about giving the wrong drug or missing a diagnosis. It is also the deliberate contribution to climate change caused by our current level of waste. TJC and Leapfrog have specific quality metrics holding healthcare organizations accountable for health-related outcomes – environmental impact must be part of this.

Until we view the climate impacts of health in the same way that we give the wrong medicine, our patients will continue to suffer unnecessarily.

Elizabeth Cerceo, MD, is an academic hospitalist who lives in Cherry Hill, New Jersey. The ideas expressed in this article are his own and do not express the views or opinions of his employer.