1 00:00:00,160 --> 00:00:03,120 Welcome to the Becker's Healthcare podcast. I'm Mariah 2 00:00:03,120 --> 00:00:05,759 Taylor, assistant editor, and I'm thrilled to have 3 00:00:05,759 --> 00:00:06,740 Arash Motamed, 4 00:00:07,120 --> 00:00:07,620 anesthesiologist 5 00:00:08,400 --> 00:00:10,419 and medical director of sustainability 6 00:00:10,800 --> 00:00:12,820 with Keck Medicine of USC 7 00:00:13,119 --> 00:00:16,244 on the podcast today. Doctor motamed, thank you 8 00:00:16,244 --> 00:00:18,484 so much for joining me. I'm really excited 9 00:00:18,484 --> 00:00:20,664 to learn more about how you're discontinuing 10 00:00:21,045 --> 00:00:23,285 nitrous oxide in the o r. But before 11 00:00:23,285 --> 00:00:25,204 we jump into that, I'd love if you 12 00:00:25,204 --> 00:00:27,044 could introduce yourself a little bit and tell 13 00:00:27,044 --> 00:00:28,884 us a little bit more about why you 14 00:00:28,884 --> 00:00:30,425 discontinued nitrous oxide. 15 00:00:31,149 --> 00:00:33,070 Well, hi, Maria. Thank you for having me 16 00:00:33,070 --> 00:00:34,990 on your podcast. It's my pleasure to be 17 00:00:34,990 --> 00:00:37,469 here today. I'll start off with, you know, 18 00:00:37,469 --> 00:00:39,890 my story and involvement with nitrous oxide. 19 00:00:40,510 --> 00:00:42,369 It started off with a pretty 20 00:00:42,750 --> 00:00:45,969 casual conversation with a colleague of mine who 21 00:00:46,695 --> 00:00:49,195 works at a competing medical center, 22 00:00:49,734 --> 00:00:51,655 and he was the one that first let 23 00:00:51,655 --> 00:00:52,715 me know what the 24 00:00:53,335 --> 00:00:55,575 problem with nitrous oxide is. And for those 25 00:00:55,575 --> 00:00:57,895 who may not know, it's also known as 26 00:00:57,895 --> 00:00:59,655 the laughing gas. It's a type of an 27 00:00:59,655 --> 00:01:00,875 anesthetic inhalational 28 00:01:01,255 --> 00:01:01,755 that 29 00:01:02,200 --> 00:01:05,159 has been used for over a century, but 30 00:01:05,159 --> 00:01:07,579 really started to gain a lot of popularity, 31 00:01:09,159 --> 00:01:12,140 in the latter half of this past century, 32 00:01:13,079 --> 00:01:15,825 and has some really great benefits in terms 33 00:01:15,825 --> 00:01:17,605 of quick onset, quick offset, 34 00:01:18,224 --> 00:01:20,564 and also, you know, very available 35 00:01:21,105 --> 00:01:21,924 and inexpensive. 36 00:01:22,704 --> 00:01:23,984 But what he told me at that time, 37 00:01:23,984 --> 00:01:26,805 which is really sort of the start of 38 00:01:27,025 --> 00:01:29,825 my journey in discontinuing nitrous oxide from our 39 00:01:29,825 --> 00:01:31,045 medical center, was 40 00:01:31,640 --> 00:01:34,439 a majority of the nitrous oxide that's in 41 00:01:34,439 --> 00:01:37,079 the central pipelines and the hospitals leaks into 42 00:01:37,079 --> 00:01:39,159 the atmosphere. So when they've done studies to 43 00:01:39,159 --> 00:01:41,879 look at that, they say anywhere from seventy 44 00:01:41,879 --> 00:01:44,040 five up to ninety five percent of the 45 00:01:44,040 --> 00:01:45,500 nitrous oxide leaks, 46 00:01:45,915 --> 00:01:48,335 typically at the areas of the connections. 47 00:01:49,034 --> 00:01:51,454 And there's really no way to prevent this. 48 00:01:51,594 --> 00:01:53,835 And, you know, what's interesting about it is 49 00:01:53,915 --> 00:01:54,814 what it means 50 00:01:55,194 --> 00:01:56,895 is that the nitrous actually 51 00:01:57,594 --> 00:01:59,915 never has any clinical impact. It just goes 52 00:01:59,915 --> 00:02:01,980 straight into the atmosphere. And then the next 53 00:02:01,980 --> 00:02:03,340 question is, well, why do we care about 54 00:02:03,340 --> 00:02:04,959 it? We do because 55 00:02:05,420 --> 00:02:07,920 nitrous oxide is a fairly potent 56 00:02:08,460 --> 00:02:09,439 greenhouse gas, 57 00:02:10,780 --> 00:02:11,919 about 300 times, 58 00:02:12,300 --> 00:02:13,599 as potent as carbon 59 00:02:14,034 --> 00:02:16,034 dioxide. So it really has a big impact. 60 00:02:16,034 --> 00:02:17,875 And on top of it, it does also 61 00:02:17,875 --> 00:02:20,275 deplete the ozone layer. And then one other 62 00:02:20,275 --> 00:02:22,354 thing with it is it lasts for a 63 00:02:22,354 --> 00:02:24,294 pretty long amount of time in the atmosphere, 64 00:02:24,354 --> 00:02:26,514 so about hundred years or so. So in 65 00:02:26,514 --> 00:02:29,270 some ways, some of the first nitrous oxides 66 00:02:29,270 --> 00:02:31,349 that were being used as anesthetics are still 67 00:02:31,349 --> 00:02:32,490 somewhere in our atmosphere, 68 00:02:33,189 --> 00:02:35,669 and most of it had gone unused in 69 00:02:35,669 --> 00:02:36,730 terms of, 70 00:02:37,349 --> 00:02:37,849 clinical 71 00:02:38,230 --> 00:02:40,469 benefit to the patient. Now we know the 72 00:02:40,469 --> 00:02:42,834 patient still gets the amount that we want 73 00:02:42,834 --> 00:02:44,594 the patient to get, but majority of it 74 00:02:44,594 --> 00:02:46,275 just leaks before it ever, 75 00:02:47,235 --> 00:02:48,375 gets to the patient. 76 00:02:49,235 --> 00:02:51,894 So knowing that and, you know, my involvement 77 00:02:52,034 --> 00:02:53,254 with our sustainability 78 00:02:53,634 --> 00:02:55,814 efforts at Keck, I felt 79 00:02:56,489 --> 00:02:58,090 compelled that we need to look at this 80 00:02:58,090 --> 00:02:59,610 and we need to figure out a way 81 00:02:59,610 --> 00:03:01,310 to better address it. And and, 82 00:03:01,930 --> 00:03:04,810 hospitals, nitrous oxide commonly comes in two forms. 83 00:03:04,810 --> 00:03:07,449 So either cylinders that gets attached to the 84 00:03:07,449 --> 00:03:08,590 anesthesia machine 85 00:03:08,965 --> 00:03:11,685 or central pipes that, again, gets connected to 86 00:03:11,685 --> 00:03:12,824 the anesthesia machine. 87 00:03:13,125 --> 00:03:15,125 Almost all the times, if a place has 88 00:03:15,125 --> 00:03:17,364 the central pipes, that's what they use, and 89 00:03:17,364 --> 00:03:19,364 the cylinder is used as a backup, you 90 00:03:19,364 --> 00:03:21,364 know, should there ever be any issues with 91 00:03:21,364 --> 00:03:22,504 central supply. 92 00:03:23,129 --> 00:03:25,129 So what we wanted to do was look 93 00:03:25,129 --> 00:03:27,450 at our usage at our medical center and 94 00:03:27,450 --> 00:03:29,849 decide, you know, whether it makes sense to 95 00:03:29,849 --> 00:03:30,990 discontinue it. 96 00:03:31,689 --> 00:03:34,010 The challenge with doing that, you know, one 97 00:03:34,010 --> 00:03:34,510 is, 98 00:03:35,290 --> 00:03:37,870 education and making sure that everyone has 99 00:03:38,905 --> 00:03:40,905 awareness as to why we're doing what we're 100 00:03:40,905 --> 00:03:42,205 doing, but, also, 101 00:03:42,745 --> 00:03:43,245 it's 102 00:03:44,185 --> 00:03:48,104 partnering with our, colleagues at facilities because, you 103 00:03:48,104 --> 00:03:49,164 know, as an anesthesiologist, 104 00:03:49,465 --> 00:03:52,264 I know nothing about, the central pipelines, how 105 00:03:52,264 --> 00:03:53,724 they work, and how they function. 106 00:03:55,200 --> 00:03:56,800 And, also, you know, at the end of 107 00:03:56,800 --> 00:03:59,540 the day, this is a medication that anesthesiologists 108 00:04:00,080 --> 00:04:01,379 have used for 109 00:04:01,760 --> 00:04:04,819 many decades. So there is clinical comfort, 110 00:04:05,360 --> 00:04:07,860 and when established habits that is, 111 00:04:09,435 --> 00:04:10,814 takes some time to, 112 00:04:11,435 --> 00:04:13,275 get them to see and understand and look 113 00:04:13,275 --> 00:04:15,215 at other alternatives. So that's 114 00:04:15,754 --> 00:04:16,254 the 115 00:04:16,555 --> 00:04:18,634 basics of the beginnings of how we got 116 00:04:18,634 --> 00:04:21,694 involved with, getting rid of, nitrous oxide. 117 00:04:22,839 --> 00:04:25,160 Excellent. And how did you build a credible 118 00:04:25,160 --> 00:04:27,500 business and clinical case for this initiative? 119 00:04:27,959 --> 00:04:29,800 And then on top of that, how did 120 00:04:29,800 --> 00:04:33,099 you get both hospital leadership and frontline physicians 121 00:04:33,160 --> 00:04:33,975 aligned on it? 122 00:04:34,855 --> 00:04:36,855 Yeah. That's a that's a really great question, 123 00:04:36,855 --> 00:04:38,455 and I think goes to heart of any 124 00:04:38,455 --> 00:04:40,395 type of initiative we try to do. 125 00:04:41,014 --> 00:04:42,694 It really needs to be collaborative, and you 126 00:04:42,694 --> 00:04:43,975 need to have the buy in because, otherwise, 127 00:04:43,975 --> 00:04:45,514 it's just not gonna go anywhere. 128 00:04:45,895 --> 00:04:46,170 What, 129 00:04:46,889 --> 00:04:50,029 I decided to do in this particular instance 130 00:04:50,090 --> 00:04:50,590 was, 131 00:04:51,050 --> 00:04:51,550 initially, 132 00:04:51,930 --> 00:04:52,430 I, 133 00:04:52,970 --> 00:04:55,629 you know, our department in anesthesia is about 134 00:04:55,770 --> 00:04:56,810 almost 200, 135 00:04:57,050 --> 00:04:57,550 individuals, 136 00:04:58,090 --> 00:05:01,230 combination of physicians, CRNAs, and, residents. 137 00:05:02,415 --> 00:05:03,794 And I picked 138 00:05:04,095 --> 00:05:05,714 about 20 of them who 139 00:05:06,175 --> 00:05:08,735 either have leadership roles or, you know, are 140 00:05:08,735 --> 00:05:11,294 otherwise still fairly influential or have, you know, 141 00:05:11,294 --> 00:05:13,154 a lot of experience and expertise, 142 00:05:13,855 --> 00:05:16,334 and I pulled them. And my first question 143 00:05:16,334 --> 00:05:18,220 to them was, you know, are there any 144 00:05:18,220 --> 00:05:20,540 types of cases that we do where nitrous 145 00:05:20,540 --> 00:05:22,639 oxide is really the only 146 00:05:23,019 --> 00:05:26,060 type of anesthetic we should use for? Because 147 00:05:26,060 --> 00:05:26,959 if that answer 148 00:05:27,339 --> 00:05:29,500 comes back as yes and a fair amount, 149 00:05:29,500 --> 00:05:31,305 then it's a different question. But, you know, 150 00:05:31,384 --> 00:05:33,865 as an anesthesiologist myself, I know the answer 151 00:05:33,865 --> 00:05:34,604 is no. 152 00:05:35,464 --> 00:05:37,384 And that was the response that I got, 153 00:05:37,384 --> 00:05:39,384 which was great. So then it led to 154 00:05:39,384 --> 00:05:41,625 the next question on on the next round 155 00:05:41,625 --> 00:05:43,485 of surveys that we did, which was, 156 00:05:43,865 --> 00:05:46,160 since we know that, you know, 157 00:05:46,540 --> 00:05:48,240 it's not a must have, 158 00:05:48,620 --> 00:05:50,000 can we have the option 159 00:05:50,379 --> 00:05:50,879 of, 160 00:05:51,180 --> 00:05:53,340 a, fully getting rid of everything that we 161 00:05:53,340 --> 00:05:53,840 have? 162 00:05:54,379 --> 00:05:54,879 Two, 163 00:05:55,340 --> 00:05:55,840 discontinuing 164 00:05:56,300 --> 00:05:59,600 the central pipeline and just having the cylinders 165 00:05:59,660 --> 00:06:01,394 as backup should anyone need it? 166 00:06:01,954 --> 00:06:02,854 Or three, 167 00:06:03,794 --> 00:06:07,154 removing everything, but having a few cylinders somewhere 168 00:06:07,154 --> 00:06:09,394 in the building as backup should anyone need 169 00:06:09,394 --> 00:06:11,074 it, and we'll bring it up and connect 170 00:06:11,074 --> 00:06:12,055 it to the machine. 171 00:06:12,595 --> 00:06:13,735 And it was interesting 172 00:06:14,100 --> 00:06:16,020 that, you know, through that process and, of 173 00:06:16,020 --> 00:06:18,339 course, as as these surveys are happening, there's, 174 00:06:18,339 --> 00:06:19,160 you know, education, 175 00:06:20,180 --> 00:06:22,020 with the department and forms of, you know, 176 00:06:22,020 --> 00:06:22,839 grand rounds, 177 00:06:23,300 --> 00:06:24,819 to let them know what the impact of 178 00:06:24,819 --> 00:06:27,240 nitrous oxide is. But most of the group 179 00:06:27,495 --> 00:06:29,194 felt comfortable moving towards 180 00:06:29,574 --> 00:06:31,735 an approach where we remove everything from the 181 00:06:31,735 --> 00:06:33,814 OR. So it's not there ready to be 182 00:06:33,814 --> 00:06:34,314 used, 183 00:06:34,694 --> 00:06:37,495 but we'll have cylinders available should we ever 184 00:06:37,495 --> 00:06:39,014 be in a need where someone feels like 185 00:06:39,014 --> 00:06:40,694 that that is the best thing for for 186 00:06:40,694 --> 00:06:42,699 their patient at that point in time. So 187 00:06:42,699 --> 00:06:44,479 we reserved four cylinders, 188 00:06:45,099 --> 00:06:47,099 where we keep all the the gas cylinders 189 00:06:47,099 --> 00:06:49,979 in our hospital and created a pathway that, 190 00:06:49,979 --> 00:06:51,659 you know, is easy to follow and a 191 00:06:51,659 --> 00:06:53,979 phone number to dial, and the person comes 192 00:06:53,979 --> 00:06:56,384 in and helps set it up. And what 193 00:06:56,384 --> 00:06:57,365 was really interesting 194 00:06:57,665 --> 00:06:58,165 was, 195 00:06:59,345 --> 00:07:00,404 in the last 196 00:07:01,185 --> 00:07:03,745 three years at our Keck Hospital and two 197 00:07:03,745 --> 00:07:06,225 years at Norris Cancer Hospital, not a single 198 00:07:06,225 --> 00:07:08,625 time has anyone needed to make that phone 199 00:07:08,625 --> 00:07:09,125 call, 200 00:07:09,709 --> 00:07:11,250 which essentially made us, 201 00:07:11,870 --> 00:07:12,370 the, 202 00:07:12,990 --> 00:07:14,509 only institution that I know of in The 203 00:07:14,509 --> 00:07:17,649 US that has fully removed nitrous oxide from 204 00:07:17,949 --> 00:07:20,449 both central supply and the cylinders. 205 00:07:22,125 --> 00:07:22,944 That's incredible. 206 00:07:23,645 --> 00:07:25,645 What were some of those key learnings you 207 00:07:25,645 --> 00:07:27,564 had when you were moving this from a 208 00:07:27,564 --> 00:07:28,944 concept into execution? 209 00:07:30,125 --> 00:07:31,665 So one of the, 210 00:07:32,444 --> 00:07:32,944 interesting 211 00:07:33,324 --> 00:07:35,085 things that came up that we did not 212 00:07:35,085 --> 00:07:36,064 know was 213 00:07:36,610 --> 00:07:38,370 the way the nitrous is set up to 214 00:07:38,370 --> 00:07:40,770 the machine. Once you discontinue it, that machine 215 00:07:40,770 --> 00:07:43,009 could no longer do its self check and 216 00:07:43,009 --> 00:07:44,610 would give a lot of errors, so it 217 00:07:44,610 --> 00:07:45,509 would be nonfunctional. 218 00:07:46,770 --> 00:07:49,009 So we first had tried this on one 219 00:07:49,009 --> 00:07:50,694 of our spare machines just to see what 220 00:07:50,694 --> 00:07:52,295 happens. And once we realized that that's a 221 00:07:52,295 --> 00:07:53,595 problem, we needed to 222 00:07:53,975 --> 00:07:55,355 connect with the manufacturer, 223 00:07:56,295 --> 00:07:58,215 and have one of their representatives come in 224 00:07:58,215 --> 00:08:00,134 because they needed, you know, special codes to 225 00:08:00,134 --> 00:08:02,215 go in there and change the machine check 226 00:08:02,215 --> 00:08:03,814 so that it doesn't alarm and it can 227 00:08:03,814 --> 00:08:05,574 still do itself check and it can still 228 00:08:05,574 --> 00:08:08,129 function. So that was an interesting learning point. 229 00:08:08,189 --> 00:08:10,129 But one of the other things that was, 230 00:08:11,470 --> 00:08:13,810 could potentially sometimes I think in other institutions 231 00:08:13,870 --> 00:08:17,310 also be viewed as barrier is the term 232 00:08:17,310 --> 00:08:19,629 that gets used frequently when it comes to 233 00:08:19,629 --> 00:08:21,729 removing nitrous oxide from central 234 00:08:22,165 --> 00:08:24,745 supply or central pipelines is decommissioning. 235 00:08:25,444 --> 00:08:27,764 And decommissioning can mean different things to different 236 00:08:27,764 --> 00:08:30,485 people as as I have learned, and it 237 00:08:30,485 --> 00:08:32,825 could be anything from we're just not using 238 00:08:32,965 --> 00:08:34,725 the pipes to we need to go into 239 00:08:34,725 --> 00:08:36,725 the building and we need to remove pipes, 240 00:08:36,725 --> 00:08:37,625 which, of course, 241 00:08:38,539 --> 00:08:41,500 is not only a construction nightmare, but also 242 00:08:41,500 --> 00:08:44,220 fairly expensive and, you know, regulatory challenges that, 243 00:08:44,220 --> 00:08:46,879 you know, may come with it. Our approach 244 00:08:46,940 --> 00:08:48,080 to decommissioning 245 00:08:48,459 --> 00:08:50,059 was not to do any of that. It 246 00:08:50,059 --> 00:08:51,440 was to simply 247 00:08:51,975 --> 00:08:55,595 stop having nitrous oxide in those central pipelines. 248 00:08:55,735 --> 00:08:58,934 And then our the our team with, the 249 00:08:58,934 --> 00:09:01,254 facilities management actually came up with a really 250 00:09:01,254 --> 00:09:04,054 brilliant and unique idea, which I think can 251 00:09:04,054 --> 00:09:05,815 be used by other hospitals as well, which 252 00:09:05,815 --> 00:09:08,990 is to fill that pipes with, nitrogen, 253 00:09:09,450 --> 00:09:12,509 which is also another gas that helps preserve 254 00:09:12,649 --> 00:09:15,290 the integrity of the pipes should there be 255 00:09:15,290 --> 00:09:17,129 some other use for them down the line, 256 00:09:17,529 --> 00:09:19,290 for some other form of gas. But at 257 00:09:19,290 --> 00:09:21,904 the same time, it's also inexpensive, and it 258 00:09:21,904 --> 00:09:24,245 doesn't have any negative environmental impact. 259 00:09:25,024 --> 00:09:27,985 That's amazing. Some really interesting problem solving and, 260 00:09:27,985 --> 00:09:30,065 you know, issues that probably nobody had thought 261 00:09:30,065 --> 00:09:31,285 about before you tried. 262 00:09:31,665 --> 00:09:33,345 So I'm curious if we take kind of 263 00:09:33,345 --> 00:09:35,049 a step back. And when you're evaluating 264 00:09:35,830 --> 00:09:38,470 sustainability initiatives as a whole, how are you 265 00:09:38,470 --> 00:09:42,009 balancing the environmental impact with the financial performance, 266 00:09:42,149 --> 00:09:44,889 clinical outcomes, all the operational feasibility, 267 00:09:45,350 --> 00:09:47,450 and then how are you measuring the success 268 00:09:47,669 --> 00:09:49,370 beyond just emissions numbers? 269 00:09:50,414 --> 00:09:53,215 Yeah. That's the that's the tough question that 270 00:09:53,215 --> 00:09:55,294 we try to figure out. Actually, with every 271 00:09:55,294 --> 00:09:57,294 single project that we do, we're fortunate in 272 00:09:57,294 --> 00:09:57,794 that, 273 00:09:58,575 --> 00:09:59,554 at our institution, 274 00:10:00,575 --> 00:10:03,054 there has been, you know, support to the 275 00:10:03,054 --> 00:10:03,554 sustainability 276 00:10:03,934 --> 00:10:04,434 program. 277 00:10:05,299 --> 00:10:07,700 So we have a chief of sustainability and 278 00:10:07,700 --> 00:10:09,399 a sustainability program manager. 279 00:10:09,860 --> 00:10:11,779 And along with, you know, me and my 280 00:10:11,779 --> 00:10:13,459 role, what we try to do with all 281 00:10:13,459 --> 00:10:15,940 of these initiatives is partner with the various 282 00:10:15,940 --> 00:10:16,440 stakeholders 283 00:10:16,899 --> 00:10:17,799 at our hospital, 284 00:10:18,235 --> 00:10:20,715 you know, whether it's, you know, obtaining data 285 00:10:20,715 --> 00:10:23,054 or whether it's talking with supply chain 286 00:10:23,434 --> 00:10:24,654 to try to figure 287 00:10:25,195 --> 00:10:26,735 out what the impact is 288 00:10:27,355 --> 00:10:28,174 both financially 289 00:10:28,554 --> 00:10:30,315 and to the some of the contracts because, 290 00:10:30,315 --> 00:10:32,039 you know, the hospitals may be tied to 291 00:10:32,120 --> 00:10:33,720 certain contracts, so we can't just suddenly go 292 00:10:33,720 --> 00:10:35,259 and say this is what we wanna do. 293 00:10:36,039 --> 00:10:37,959 And then, of course, the 294 00:10:38,440 --> 00:10:39,959 I would say both, you know, the return 295 00:10:39,959 --> 00:10:42,120 on investment from an environmental point of view 296 00:10:42,120 --> 00:10:43,980 or from a cost point of view. 297 00:10:44,440 --> 00:10:45,419 There are projects 298 00:10:45,799 --> 00:10:48,365 that, you know, will be very expensive with 299 00:10:48,365 --> 00:10:49,664 maybe not so much, 300 00:10:50,284 --> 00:10:51,584 significant environmental 301 00:10:52,044 --> 00:10:55,004 impact in terms of reducing carbon footprint, and 302 00:10:55,004 --> 00:10:57,644 then there's projects that are exactly opposite. So 303 00:10:57,644 --> 00:11:00,205 in our approach so one, we collect as 304 00:11:00,205 --> 00:11:01,825 much data as we can, 305 00:11:02,879 --> 00:11:05,860 to before, during, and after. And we have 306 00:11:06,240 --> 00:11:06,740 committees, 307 00:11:07,279 --> 00:11:09,679 that meet very regularly on a monthly basis 308 00:11:09,679 --> 00:11:10,980 with all the various, 309 00:11:11,360 --> 00:11:11,860 individuals, 310 00:11:12,480 --> 00:11:14,965 within the health system that play a role 311 00:11:14,965 --> 00:11:17,044 in one form or another and the the 312 00:11:17,044 --> 00:11:19,304 care that we deliver to make sure everyone's, 313 00:11:19,924 --> 00:11:22,404 on board with the projects and it makes 314 00:11:22,404 --> 00:11:22,904 sense. 315 00:11:23,605 --> 00:11:24,585 Of course, clinicians, 316 00:11:25,684 --> 00:11:28,059 are very much involved in we, you know, 317 00:11:28,059 --> 00:11:29,820 we really listen to their input, and that's 318 00:11:29,820 --> 00:11:31,340 part of my role is to bring them 319 00:11:31,340 --> 00:11:33,340 on board and make sure, you know, nothing 320 00:11:33,340 --> 00:11:35,660 that we do ultimately has a negative impact 321 00:11:35,660 --> 00:11:36,639 on patient care. 322 00:11:37,100 --> 00:11:38,779 But what we try to do, I would 323 00:11:38,779 --> 00:11:41,179 say, on a very high level is most 324 00:11:41,179 --> 00:11:43,394 of the projects that we decided to tackle 325 00:11:43,394 --> 00:11:46,215 earlier on were the types of projects that 326 00:11:46,434 --> 00:11:48,754 would achieve both. And that's, I think, one 327 00:11:48,754 --> 00:11:50,674 of the other misconceptions with a lot of 328 00:11:50,674 --> 00:11:53,315 these efforts to reduce the carbon footprint, of 329 00:11:53,315 --> 00:11:55,715 care delivery is everyone just assumes it's gonna 330 00:11:55,715 --> 00:11:56,375 be expensive. 331 00:11:56,919 --> 00:11:58,120 And when you look at, you know, how 332 00:11:58,120 --> 00:12:00,460 can we better be better for our environment, 333 00:12:00,519 --> 00:12:02,279 the number one thing everyone just says is, 334 00:12:02,279 --> 00:12:03,660 you know, reduce waste. 335 00:12:04,519 --> 00:12:08,460 Reducing waste is obviously, you know, financially beneficial 336 00:12:08,519 --> 00:12:10,200 as well as well, you know, in in 337 00:12:10,200 --> 00:12:11,179 addition to, 338 00:12:11,995 --> 00:12:15,034 reducing the negative impact of the on the 339 00:12:15,034 --> 00:12:16,815 environment. In in 340 00:12:17,195 --> 00:12:18,095 health systems, 341 00:12:18,794 --> 00:12:21,434 there is a fair amount of waste. And 342 00:12:21,434 --> 00:12:24,074 when you look at health systems, specifically the 343 00:12:24,074 --> 00:12:26,529 academic medical centers and part of that cost 344 00:12:26,529 --> 00:12:27,309 of education 345 00:12:28,009 --> 00:12:30,490 also becomes access waste. So, you know, for 346 00:12:30,490 --> 00:12:31,929 all of us who, you know, myself as 347 00:12:31,929 --> 00:12:32,590 an anesthesiologist 348 00:12:32,970 --> 00:12:35,290 in the operating room, we do see that 349 00:12:35,290 --> 00:12:37,550 all the time. And part of it is, 350 00:12:38,570 --> 00:12:39,389 just the 351 00:12:39,965 --> 00:12:43,085 the practice of medicine and helping teach somebody 352 00:12:43,085 --> 00:12:45,264 else and helping somebody else become, 353 00:12:46,045 --> 00:12:48,445 a clinician. But I think the other part 354 00:12:48,445 --> 00:12:51,404 of it is we've historically, as an entity, 355 00:12:51,404 --> 00:12:51,904 never 356 00:12:52,360 --> 00:12:54,600 truly looked at how much waste we generate 357 00:12:54,600 --> 00:12:56,440 and what the impact is. And now we 358 00:12:56,440 --> 00:12:58,379 know that health care is one of the, 359 00:12:58,840 --> 00:13:00,759 you know, leading industries when it comes to, 360 00:13:02,519 --> 00:13:05,154 greenhouse gas emissions. You know, studies have said, 361 00:13:05,154 --> 00:13:07,154 at least in The US, anywhere from eight 362 00:13:07,154 --> 00:13:07,975 to 10%, 363 00:13:08,195 --> 00:13:10,855 and we're much higher compared to other institutions 364 00:13:10,995 --> 00:13:12,134 outside of the country. 365 00:13:12,995 --> 00:13:15,394 Absolutely. And I know here at Becker's, we've 366 00:13:15,394 --> 00:13:17,475 seen a lot of hospitals that are starting 367 00:13:17,475 --> 00:13:20,100 to move forward with sustainability initiatives in a 368 00:13:20,100 --> 00:13:21,159 lot of different ways. 369 00:13:21,539 --> 00:13:24,259 But I'm curious from your experience, where do 370 00:13:24,259 --> 00:13:27,059 you see the biggest untapped opportunities for hospitals 371 00:13:27,059 --> 00:13:28,919 to reduce their environment footprint? 372 00:13:29,700 --> 00:13:31,504 Yeah. I I think from my point of 373 00:13:31,504 --> 00:13:34,565 view, the the biggest untapped opportunity is still 374 00:13:34,705 --> 00:13:35,684 lack of education. 375 00:13:36,785 --> 00:13:39,424 I I think, you know, again, using myself 376 00:13:39,424 --> 00:13:40,644 as as the 377 00:13:41,024 --> 00:13:43,264 example of it. The first time I went 378 00:13:43,264 --> 00:13:46,679 into a, grand rounds where some individual was 379 00:13:46,679 --> 00:13:47,659 talking about the impact 380 00:13:48,519 --> 00:13:50,600 of care delivery on carbon footprint was sort 381 00:13:50,600 --> 00:13:52,279 of my moment of, you know, I need 382 00:13:52,279 --> 00:13:53,720 to get involved, and what do I need 383 00:13:53,720 --> 00:13:56,039 to do? And I think that is there's 384 00:13:56,039 --> 00:13:58,299 still a great opportunity there, and 385 00:13:58,759 --> 00:14:01,000 clinicians really need to be involved. There are 386 00:14:01,000 --> 00:14:01,240 some, 387 00:14:02,325 --> 00:14:04,644 hospitals or health care systems where they're doing 388 00:14:04,644 --> 00:14:05,465 a fair amount, 389 00:14:06,485 --> 00:14:07,144 in terms 390 00:14:07,845 --> 00:14:11,045 of reducing energy usage or water usage, but 391 00:14:11,045 --> 00:14:12,985 the clinicians haven't been fully, 392 00:14:14,404 --> 00:14:15,465 engaged. So 393 00:14:16,080 --> 00:14:19,460 educating and connecting both the hospital, 394 00:14:21,680 --> 00:14:24,559 administrative side and the clinical side together, I 395 00:14:24,559 --> 00:14:26,480 think, really makes a big difference from our 396 00:14:26,480 --> 00:14:28,320 point of view. You know, once once we 397 00:14:28,320 --> 00:14:31,059 got that group together, the project's just one 398 00:14:31,304 --> 00:14:33,245 feeds the other. You know, when we started 399 00:14:33,705 --> 00:14:36,184 our monthly OR group, talking about how can 400 00:14:36,184 --> 00:14:38,504 we, you know, do better in the peri 401 00:14:38,504 --> 00:14:39,245 op setting, 402 00:14:39,705 --> 00:14:41,945 I remember the first session I had, you 403 00:14:41,945 --> 00:14:43,465 know, afterwards, I'm like, oh my god. I 404 00:14:43,465 --> 00:14:44,904 have nothing to say next month. I just 405 00:14:44,904 --> 00:14:46,524 went over everything I had to say. 406 00:14:46,980 --> 00:14:48,580 And now it's at a point, you know, 407 00:14:48,580 --> 00:14:50,580 two years later where there's not enough time 408 00:14:50,580 --> 00:14:52,259 to keep talking about all the different things 409 00:14:52,259 --> 00:14:53,480 that people wanna do. 410 00:14:54,259 --> 00:14:56,980 The different folks in the hospital, whatever their 411 00:14:56,980 --> 00:14:59,220 role and responsibility is, are the ones that 412 00:14:59,220 --> 00:15:00,839 come to us with the ideas. 413 00:15:01,174 --> 00:15:02,774 We have one of the individuals at our 414 00:15:02,774 --> 00:15:03,674 hospital that, 415 00:15:04,214 --> 00:15:06,214 does patient transport is the one that, you 416 00:15:06,214 --> 00:15:07,814 know, came up with idea of how to 417 00:15:07,814 --> 00:15:10,314 try to create bins for, 418 00:15:10,694 --> 00:15:14,049 the the significant battery waste, that we have 419 00:15:14,049 --> 00:15:15,730 in hospital for all the devices that we 420 00:15:15,730 --> 00:15:18,529 use. So the idea is slow once you 421 00:15:18,529 --> 00:15:20,149 have that set up, 422 00:15:20,690 --> 00:15:23,110 and, you know, you have the key individuals 423 00:15:23,250 --> 00:15:24,769 involved. So I think from my point of 424 00:15:24,769 --> 00:15:26,835 view, the biggest barrier is that first step. 425 00:15:26,915 --> 00:15:28,355 And once you take that first step, it 426 00:15:28,355 --> 00:15:30,195 just ends up feeding itself. And at the 427 00:15:30,195 --> 00:15:31,875 end of the day, gets us to a 428 00:15:31,875 --> 00:15:32,934 place where we 429 00:15:33,394 --> 00:15:35,875 deliver better care because in my view, the 430 00:15:35,875 --> 00:15:37,634 best care you can deliver is also the 431 00:15:37,634 --> 00:15:39,809 most sustainable one where the patient does well 432 00:15:39,809 --> 00:15:40,930 and they don't have to come back to 433 00:15:40,930 --> 00:15:42,710 the hospital again or be readmitted 434 00:15:43,170 --> 00:15:45,330 to the hospital or have a prolonged hospital 435 00:15:45,330 --> 00:15:45,830 stay. 436 00:15:46,850 --> 00:15:47,350 And, 437 00:15:47,889 --> 00:15:49,809 as you we do that, we're able to 438 00:15:49,809 --> 00:15:51,330 deliver more care and actually do it in 439 00:15:51,330 --> 00:15:53,350 the most cost effective way. So for me, 440 00:15:54,315 --> 00:15:57,434 that mentality is just very much aligned with 441 00:15:57,434 --> 00:16:00,315 value care that we, you know, aspire to 442 00:16:00,315 --> 00:16:00,815 deliver. 443 00:16:01,915 --> 00:16:02,415 Absolutely. 444 00:16:02,794 --> 00:16:05,195 Well, this has been such an informative discussion. 445 00:16:05,195 --> 00:16:06,715 Thank you for taking the time to join 446 00:16:06,715 --> 00:16:08,955 me today and share more about everything you're 447 00:16:08,955 --> 00:16:09,455 doing. 448 00:16:09,995 --> 00:16:12,175 Thank you so much. I appreciate being here.