Sustainability Workgroup Meeting

Date: May 12, 2025, 1pm - 2pm EST via Zoom

Attendance

Henrietta Addo, MSN, RN

MPOG QI Specialist

Jonathan Paul, MD

Columbia University

Kate Buehler, MS, RN

MPOG Clinical Program Manager

Anjan Saha, MD, PhD

Columbia University

Nick Delasio, MD

Johns Hopkins

Nirav Shah, MD

MPOG Quality Director

Tony Edelman, MD, MBA

MPOG Associate QI Director

Ben Stam, MD

Corewell West and UM West

Eva Lu-Boettcher, MD

University of Wisconsin

Meridith Wade, MSN, RN

MPOG Pediatric Program Manager

Katie O’ Connor, MD, MBA

Johns Hopkins

Summary of meeting:

The meeting was focused on discussing several measures related to reducing the environmental

footprint of anesthesia practices, as well as planning for an upcoming quality committee meeting.

Agenda included the following topics:

 Review of recommendations from the April Workgroup meeting

 Review SUS-03 in detail

 Broad Discussion Topic: Sustainable practices related to laryngoscope use and decommissioning

nitrous pipelines.

Key takeaways and actions from the meeting included:

1. SUS-01/SUS-04: The workgroup proposed an additional measure to assess FGF 1L/min with

eventual retirement of SUS-01 (3L/min). Suggested removing the current exclusion for cases

under 30 minutes to promote lower flows.

2. SUS-02/SUS-03:

a. The Cuveele method (see April minutes for calculation) and GWP 20 were discussed for

more accurate carbon footprint calculations.

b. Presented results from data analysis assessing documentation of minute ventilation as

well as % expired for sevoflurane, isoflurane, and desflurane. Most sites include these

values in their MPOG extract. It would be possible to create a new measure calculating

carbon footprint based on the Cuveele method. The group recommended mentioning

this option at the Quality Committee on Monday to gain their input before considering

next steps.

c. Discussed excluding one-lung ventilation cases due to the necessity for higher flows in

such cases. Will hold on adding a ‘one lung ventilation’ exclusion at this time as there

will be corner cases that cannot be easily identified and excluded. The threshold of

90% accounts for these corner cases, estimating that ~10% of cases will not and perhaps

should not aim to meet the measure’s definition of success.

3. SUS-03: Total carbon dioxide equivalents per induction for cases where halogenated agents

and/or nitrous oxide was administered during the induction period of anesthesia.

a. Proposed new adult measure to assess fresh gas flow rates at induction to help identify

opportunities for improvement in reducing carbon footprint during induction (SUS-03).

A pediatric measure already exists (SUS-06) to assess fresh gas flow during induction.

Workgroup reviewed the ASA Fresh Gas Flow Management recommendations and

considered a threshold of 6L/min during induction for adults, although

recommendations are not clear for set FGF rate during induction for the adult

population: https://www.asahq.org/about-asa/governance-and-committees/asa-

committees/environmental-sustainability/greening-the-operating-room/fresh-gas-flow-

management

b. Discussed challenge of tracking inhalational vs. IV induction – potential to assess

documentation in event notes that identify the type of induction used.

4. Sustainability practices beyond anesthetic gas management:

a. Discussed environmental efficiency in the context of laryngoscope use: single-use

laryngoscopy blade recycling vs. sterilization process for multiple use laryngoscope

blades.

5. Review of Measures and Voting:

a. Dr. Shah (MPOG Quality Director) reviewed the process for presenting measure reviews

at the Quality Committee. Dr. Stam and Dr. Lu-Boettcher are on the agenda to present

the SUS Workgroup findings on Monday, May 19th. After their presentation and group

discussion, the Quality Committee will vote to continue, modify, or retire each adult

sustainability measure. The pediatric sustainability measures will be reviewed at the

Pediatric Subcommittee meeting scheduled for this fall.

6. Action Items:

a. Dr. Stam will prepare his review of SUS-01/SUS-04 and submit it to the Coordinating

Center by Thursday, May 15th for the review to be disseminated and reviewed by the

Quality Committee in advance of Monday’s meeting.

b. Dr. Lu-Boettcher will prepare her review of SUS-02/SUS-03 and submit her review to the

CC by Thursday, May 15th in preparation for the May 19th Quality Committee

discussion.

c. Dr. Edelman and Dr. Delasio will be meeting to share institutional practices for

laryngoscope use and decommissioning nitrous oxide.