Project SPRUCE: Formation of an International Consortium of Pediatric Anesthesia Groups to Reduce Greenhouse Gas Emissions from Inhaled Anesthetics

BACKGROUND: Inhaled anesthetic use contributes to environmental harm through release of potent greenhouse gases (GHG). Emissions can be reduced with the use of safe practice changes, including avoidance of high impact agents like desflurane and nitrous oxide, use of low fresh gas flows, and adoption of total intravenous and regional anesthesia when clinically appropriate. These evidence-based practices have been recommended for years, but actual practice changes have not been widely adopted. METHODS: The Project SPRUCE (Saving our Planet by Reducing Carbon Emissions) consortium brought together twelve pediatric anesthesia groups into a partnership working to reduce GHG emissions from pediatric anesthesia care. The consortium implemented quality improvement strategies, including change management methods, to reduce GHG emissions from inhaled anesthetics by at least 50%. Change management and quality improvement strategies were utilized to disseminate strategies, implement emissions reduction techniques, and track emissions in pediatric anesthesia care. Specific interventions included education and socialization, practice constraints, and direct data feedback to clinical teams. RESULTS: The consortium facilitated adoption of practice changes among anesthesia groups, and sustained emissions reductions though shifts in culture. Greenhouse gas emissions from inhaled anesthesia decreased by 63% (range 43-91%) During the study period, the incidence of nitrous oxide use was reduced by 62.4%, and the average volume of nitrous oxide used per case decreased by 83.5%. Project SPRUCE prevented a total of 14,381 metric tons of excess carbon dioxide equivalent (CO2e) emissions from inhaled anesthetics. CONCLUSIONS: Collaborative action within our consortium supported widespread and significant reductions in harmful greenhouse gas emissions from pediatric anesthesia care through education and socialization, practice constraints, and direct data feedback to clinical teams.