Implementing a Clinical Decision Support Tool to Reduce Operating Room Anesthetic Fresh Gas Flow: A Resident-Led, Sustainability-Focused Quality Improvement Initiative

<b>Background</b> Lowering fresh gas flow (FGF) can help decrease the carbon footprint of the operating room as FGF levels act as an indirect measure of anesthetic gas waste. <b>Objective</b> The aim of this quality improvement project was to reduce clinician FGF during general anesthesia with clinical decision support (CDS) tools within the electronic health record (EHR) at a single institution. <b>Methods</b> A non-interruptive alert to reduce FGF was coded into the anesthesia intraoperative EHR workspace to alert whenever the 10-minute average FGF exceeded 1 L/min. It was targeted at anesthesia residents, attendings, and certified registered nurse anesthetists at a single US large academic level 1 trauma center. The number of general anesthesia cases with a target FGF of ≤2 L/min and the amount of sevoflurane (L/hr) was tracked on an individual and institutional basis. <b>Results</b> Following CDS implementation from July 2023 through July 2024, 2677 of 4573 (58.5%) had a mean FGF ≤2 L/min, demonstrating a 116.7% increase from our institution's baseline of 27.0% (1200 of 4446 cases) from July 2022 to June 2023, corresponding to a sevoflurane usage reduction of 36.7%. <b>Conclusions</b> Implementing a non-interruptive alert in the EHR altered institution-level behaviors to reduce environmentally harmful anesthetic gas emissions.