E(co)-health evolution: comparative life-cycle assessment of the virtual fracture clinic versus conventional inperson follow-up

Background The Virtual Fracture Care (VFC) method is designed to minimise follow-up visits for trauma patients seen in the emergency department (ED) with non-complex and stable injuries by adopting a risk-sharing model. Given the healthcare sector’s significant carbon footprint, this study aims to assess the environmental impact of VFC-pathway direct discharge with the standard pathway with inpatient follow-up, focusing on the treatment and follow-up of torus/greenstick fractures. Methods A comparative cradle-to-grave life-cycle assessment was conducted at a Dutch ED. Data for material use, waste, packaging, transport, energy consumption, and staff and patient travel are included. Carbon footprints were calculated using SimaPro software with the ReCiPe 2016 method. The study compared the carbon footprints of the VFC pathway and standard pathway, identified key contributors, and performed a sensitivity and uncertainty analysis. Results The VFC pathway resulted in a reduction of 2.8 (95% CI 2.1 to 3.9) kilograms of carbon dioxide equivalent greenhouse gas emissions (kg CO ₂ -eq) per treatment compared with the standard pathway, which equates to an annual decrease of 625 kg CO ₂ -equivalents in 230 patients seen in our hospital. Key contributors to the difference in annual emissions were travel movements (411.7 kg CO ₂ -eq), materials (126.5 kg CO ₂ -eq) and packaging (6.9 kg CO ₂ -eq). Sensitivity analysis revealed that eliminating follow-up visits could result in an annual reduction of 805 kg CO ₂ -eq, if all patients travelled by car. Conclusion The VFC pathway reduces the CO ₂ emission of treating torus/greenstick fractures, primarily by decreasing patient travel, while patient satisfaction and material use do not increase. Broader adoption of a risk-sharing model, that is digitally supported, may reduce environmental impact across healthcare domains.