Recognizing that anesthetic gases are harmful to the environment, NAPA clinical leaders at several of our partner sites have pioneered the use of low flow anesthesia techniques in operating rooms (ORs) across the country. Low flow anesthesia is also known to have additional perioperative benefits for patients.
The evidence-based success of these initiatives inspired NAPA to implement low flow anesthesia in thousands of ORs at the nearly 400 hospitals and ASCs served by our anesthesia clinicians. In 2022, NAPA’s Quality Measure Committee created and beta tested a low flow anesthesia measure, then submitted to the ABG Qualified Clinical Data Registry (QCDR) for consideration in the Merit-based Incentive Payment System (MIPS) program. The measure was approved by the Centers for Medicare & Medicaid Services (CMS) and is now available to all anesthesia providers reporting in the Quality Payment Program under MIPS, as ABG44. NAPA’s passion for quality and proactive actions enable more healthcare providers nationwide to participate in efforts to reduce global warming by minimizing the amount of excess anesthetic gases expelled into the atmosphere.
NAPA’s leadership in promoting low flow anesthesia was widely recognized when our partner, Henrico Doctors’ Hospital in Richmond, Virginia, earned the 2023 Virginia Governor’s Environmental Excellence Gold Medal Award for Sustainability in Healthcare.
This highest honor was bestowed on the health system for low flow anesthesia and recycling initiatives developed by NAPA’s Richmond anesthesia team at five hospitals and ASCs affiliated with Henrico. Pilot studies by the NAPA team proved that adopting a low flow anesthesia technique is better for our patients, our partners, and our planet
Situation »
A typical midsize hospital in the U.S. will purchase more than 1,000 liters of costly anesthetic gases per year. Traditional “high” fresh gas flow (FGF) anesthesia using potent greenhouse gases such as Sevoflurane, Desflurane, and Nitrous Oxide generally exceeds a patient’s minimal oxygen requirements. This results in excess emissions of these anesthetic gases, which are vented into the atmosphere, where they linger for years and contribute to the “greenhouse gas” effect associated with global warming. In contrast, by using low flow anesthetic technique, anesthesia clinicians can significantly reduce the amount of wasted anesthetic gas while reducing costs.
Solution »
At Henrico Doctors’ Hospital and its affiliates, the NAPA anesthesia department leadership launched an initiative to reduce total usage of the environmentally harmful inhaled anesthetic agents Desflurane, Sevoflurane, and Nitrous Oxide. From February through May in 2020 and 2021, the hospital’s pharmacy measured Sevoflurane usage, while NAPA’s Richmond anesthesia team worked to reduce total FGF in all inhaled general anesthesia cases, thereby limiting the emissions of excess gas.
Low flow anesthesia technique also offers clinical benefits that improve the patient experience. Body temperature is better maintained during anesthesia, which reduces the patient’s postoperative shivering, and humidification in the airway and bronchial passages is better preserved. Higher heat and moisture associated with low flow gas uses have been shown to decrease pulmonary complications, including hypoxemia and atelectasis.
Results »
- During the four-month trial period for low flow anesthesia, the NAPA anesthesia teams at five sites successfully transitioned to low flow anesthesia and reduced pharmacy costs for anesthetic gases. For example, Sevoflurane use in aggregate decreased by 135 bottles, as compared to the baseline period, saving $16,875, based on an average cost of $125 per 250 ml bottle of liquid Sevoflurane. On an annualized basis, total savings exceeded $50,000, generating significant financial savings over time. In terms of ecological cost, the U.S. Environmental Protection Agency equates a 135-bottle decrease to reducing emissions from cars driving 55,000 miles.
- The NAPA Richmond team’s initiatives to implement low flow anesthesia have been enthusiastically embraced at Henrico Doctors’ Hospital and its affiliated sites, creating mission-driven, collaborative cultures that are aligned with values for corporate social responsibility.
- NAPA anesthesia clinicians at other sites are leading similar low flow initiatives, with comparable success in reducing wasted anesthetic agents and associated pharmacy costs. Additionally, as a founding member of the ABG QCDR, NAPA supports one of the country’s largest anesthesia outcomes databases, collecting quality data for more than 2 million patients each year. The ABG QCDR is a CMS-approved registry for reporting required components of the Quality Payment Program (QPP) MIPS program, with a focus on improving healthcare quality. QCDRs may contribute to better patient safety by recommending new quality measures for inclusion in CMS’s MIPS program. Inspired by our clinicians’ results and database metrics, NAPA’s Quality team recognized the opportunity to advance broad low flow anesthesia use by drafting and testing a new MIPS measure. This measure was submitted to the ABG QCDR along with face validity and test data. After the ABG QCDR’s review, the registry included the measure in their 2022 self-nomination application. The measure was approved by CMS for anesthesia MIPS QCDR quality reporting beginning in performance year 2023, clearing a path for a nationally recognized strategy that other healthcare organizations can use to promote environmental sustainability.
Small changes add up to meaningful results. NAPA clinical leaders have found that people are willing to be a catalyst for change when they are given the opportunity to make a difference. NAPA is working to lead by example, helping its partners achieve better outcomes with more fiscally and environmentally responsible anesthesia care.
References »
1. Ryan, Susan M. MD, PhD; Nielsen, Claus J. CSc. Global Warming Potential of Inhaled Anesthetics: Application to Clinical Use. Anesthesia & Analgesia 111(1):p 92-98, July 2010. | DOI: 10.1213/ ANE.0b013e3181e058d7
2. Andersen, Mads P. Sulbaek PhD; Nielsen, Ole J. PhD; Wallington, Timothy J. PhD; Karpichev, Boris PhD; Sander, Stanley P. PhD. Assessing the Impact on Global Climate from General Anesthetic Gases. Anesthesia & Analgesia 114(5):p 1081-1085, May 2012. | DOI: 10.1213/ANE.0b013e31824d6150
For more information about NAPA quality and safety innovation, reach out to Businessdevelopment@NAPAanesthesia.com or call 833-OR1-TEAM.
