Op-Ed, Social EM

Sustainability in Health Care: What is the Role of Small-Scale Accountability?

In the United States, the health care sector alone contributes 8.5% of greenhouse gas emissions, according to a 2022 White House report.¹ Global and national climate concerns are reaching the forefront of public and environmental health discussions, opening the doors of opportunity to encourage accountability and action toward environmental sustainability within the health care industry.

Health care is uniquely interconnected with the state of the environment, as factors like pollution, temperature and weather extremes, and food insecurity are all issues at the heart of climate change that threaten public health. The Centers for Disease Control and Prevention endorses that climate disturbances are linked to the burdens of respiratory disease, cardiovascular disease, infectious disease, injury, premature death, and stressors affecting mental health.² Ongoing efforts to mitigate the carbon footprint of the health care sector are outlined in the Biden administration’s Health Sector Climate Pledge, which includes various sustainability commitments made by private and public health systems, suppliers, and medical associations to work toward a goal of net-zero emissions by the year 2050.

On the other hand, not all entities within the health care sector are aligned with this national agreement, likely due to competing stakeholder financial and political priorities.

Opportunities for Small-Scale Sustainability
Amid a push for large-scale commitments to sustainability, small-scale interventions seem to be de-emphasized — although I would argue that environmental responsibility starts at the individual and team level. In my experience as a medical student rotating through multiple departments and locations within a multi-state nonprofit health system, I noted firsthand various unsustainable practices in everyday workflow, with potential for improvement requiring minimal buy-in. For example, hundreds of pages of single-sided discharge paperwork passed through my hands in just 3 weeks of working in an emergency department that discharges more than 47,000 patients annually, per departmental data collected in fiscal year 2020.

Initiatives aimed at reducing unnecessary paper usage are low-hanging fruit for sustainability-friendly change at the department level, and these small-scale opportunities can lead to large-scale impact in a nation that documented more than 30,000 ED “treat-and-release” discharges per 100,000 persons in the population, according to 2018 data published by the Agency for Healthcare Research and Quality.³

Opportunities abound to tackle reducing paper usage related to discharge summaries ED patients. In an ED that currently prints single-sided discharge summaries for patients upon departure, switching to double-sided summaries is a straightforward solution with the potential to reduce annual paper usage by up to 50%. This is a quick, low- to no-cost solution for departments with printers already equipped with double-sided capabilities. However, this may prove a more difficult task to implement in a facility that must purchase new printers, as this requires organizational buy-in for upfront costs and technological support during the transition period. (Based on my experience working with a team to submit a proposal for a similar initiative, achieving buy-in at the administrative level is a critical obstacle to implementing any initiative requiring expenditures, regardless of projected savings or gains over the long term.)

Another approach involves condensing information included in a standard discharge summary to reduce the number of pages printed per discharge. This approach requires little to no expense, bypassing the potential financial obstacles of an administrative approval process. However, there are limitations to consider regarding what information can be abbreviated or excluded from the discharge summary without compromising patient education and outcomes.

Ultimately, adopting double-sided printing practices for discharge paperwork can accomplish significant reduction in paper usage without compromising informational content. Adequate budgeting and technological support for implementation, achieved through organizational buy-in, is key to the success of this type of initiative. In the long term, double-sided printing in the emergency department has cost-savings potential despite up-front costs for new equipment, as reducing paper usage will reduce the need for, and expense of, purchasing paper supplies for the duration of the equipment’s lifetime. Simple cost-effective interventions leading to small-scale success toward sustainability are excellent starting points to establish environmental accountability beginning at the department level, with the potential to inspire system-wide change.


  1. The United States Government. (2022, June 29). Fact sheet:  Health Sector Leaders Join Biden Administration's Pledge to Reduce Greenhouse Gas Emissions 50% by 2030. The White House. Retrieved November 30, 2022, from https://www.whitehouse.gov/briefing-room/statements-releases/2022/06/30/fact-sheet-health-sector-leaders-join-biden-administrations-pledge-to-reduce-greenhouse-gas-emissions-50-by-2030/.
  2. Centers for Disease Control and Prevention. (2022, April 25). Climate effects on health. Centers for Disease Control and Prevention. Retrieved November 30, 2022, from https://www.cdc.gov/climateandhealth/effects/default.html.
  3. Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP), Nationwide Emergency Department Sample (NEDS), State Emergency Department Databases (SEDD), and State Inpatient Databases (SID), 2019-2018.

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