Project EVERgreen Forest
Efficient Volatile Emissions Reduction for Green and Responsible Anesthesia
Principal Investigators Elizabeth Hansen and Andy Foster
Welcome to EVERgreen Forest
We are anesthesiologists dedicated to reducing the environmental footprint of our care, and we have come together to reduce emissions from anesthetic gasses using proven implementation science methods.
After a successful launch of pediatric focused Project SPRUCE Forest, we are thrilled to invite anesthesia groups from all hospitals to consider joining our cohort Project EVERgreen Forest – a multi-institutional quality improvement project to reduce anesthesia GHG emissions.
We use implementation science methods to achieve or surpass our goal of 50% reduction in GHG emissions in each participating center over 12 months.
See who has joined the Project SPRUCE Forest Pediatric consortium here.
Strategies
Practice constraints (e.g. removal of desflurane vaporizer, disconnection of wall nitrous oxide)
Nudges and default choice changes to support conversion to low-flow induction and maintenance of anesthesia (lower default fresh gas flows, clinical decision support tools, EMR-based alerts)
Educational interventions (shared literature and departmental presentations)
Protocol changes to increase utilization of IV inductions and total IV anesthetics
Tracking and sharing results in real time
Participation in monthly virtual meetings to discuss implementation strategies, to track progress, and review barriers to implementation
Center participation
To participate, you will need to:
Identify a local Principle Investigator (PI) for each center
Obtain support from your local QI leader(s) and chair/division chief
Allow the PI to participate in monthly virtual consortium report out meetings for the duration of the project
Purchase AdaptXR software solution (we have negotiated a discounted rate for this project and have applied for grant funding support)
Additional required support from each participating center may be identified as additional planning is completed
Technical and time requirements
Use an EMR that captures data from the anesthesia machine (fresh gas flows) and monitors (exhaled anesthetic gas measurements)
Secure hospital IT support (approximately 30-35 hours initial work) to generate a flat file of OR data with specific data fields that will be automatically extracted to create a daily data feed. We will provide a list of needed data fields. Each institution’s data feed will be ingested by AdaptXR , hosted on a HIPAA compliant cloud server (Amazon Web Services), accessible to the Consortium leaders and the anesthesia team members within their respective institution.
FGF and percent volatile anesthetic are used to calculate generated kg CO2e/min. Automated analyses of CO2e displayed as continuously updated statistical process control charts, stratified by surgery specialty, type of procedure, clinician (anesthesiologist, resident, fellow, CRNA), will be available via AdaptXR
PI must be able to devote 5-10 hours per month to this project
Monthly report out to the consortium on project status and progress via video calls