Influence of Practitioner Dashboard Feedback on Anesthetic Greenhouse Gas Emissions: A Prospective Performance Improvement Investigation.

Anesthetic gases contribute to global warming. We described a two-year performance improvement project to examine the association of individualized provider dashboard feedback of anesthetic gas carbon dioxide equivalent (CDE) production and median perioperative fresh gas flows (FGF) during general anesthetics during perioperative management. Using a custom structured query language (SQL) query, hourly CDE for each anesthetic gas and median FGF were determined. During the first year, practitioners were not given any feedback on their use of anesthetic gases. During the second year of the study protocol, a commercially available business intelligence platform was used to deliver individualized monthly dashboard of these parameters to each practitioner. Continuous values are expressed as median [first quartile, third quartile]. During the study period, 53,294 patients managed by 79 anesthesiologists were available for analysis. Bivariate analysis revealed an overall decrease in median FGF from 2.0 [1.9, 3.0] liters/minute (l/min) to 1.9 [1.7, 2.0] l/min (p < 0.001). There was a significant decrease in the overall total CDE from 5.10 [0,12.3] to 3.59 [0,8.78] kg/hr (p < 0.001). Multivariate analysis demonstrated an initial decrease in monthly practitioner total CDE production with the intervention (odds ratio (OR) 0.875 95% confidence interval (CI) 0.809-0.996, p < 0.001) and a faster decrease rate in monthly total CDE (OR 0.986, 95% CI 0.976-0,996, p < 0.001). Dashboard distribution initially decreased isoflurane (intervention OR 0.97 95% CI 0.96-0.99, p = 0.001) and NO (OR 0.82 95% CI 0.73-0.94, p = 0.003) CDE production and was associated with a steeper declining rate of isoflurane (OR 0.87, CI 0.79-0.94, p < 0.001) and desflurane (OR 0.9, 0.84-0.97, p = 0.005) CDE production. The intervention did not have a significant effect on the monthly rate of decline of sevoflurane or NO CDE. The average practitioner FGF decreased by 0.3 l/m (95% confidence interval (CI): -0,011, -0.5, p = 0.002) with dashboard distributions. Dashboard distribution may be an effective tool to decrease FGF as well as components of anesthetic greenhouse gas emissions.