Editor’s note: This is part of a series profiling six of the Seattle region’s “Uncommon Thinkers”: inventors, scientists, technologists and entrepreneurs transforming industries and driving positive change in the world. They will be recognized at the GeekWire Gala on Dec. 6. Uncommon Thinkers is presented in partnership with Greater Seattle Partners. Read the other profiles here.
Around five years ago, Dr. Elizabeth Hansen, an attending anesthesiologist at Seattle Children’s Hospital (SCH), lay awake in bed. She thought of her patients: sick, vulnerable kids whose airways became more reactive during wildfire season. She worried about her own young kids and whether there would be snow to play in when they were adults. What would the world be like for them?
Hansen needed to do something about climate change.
She went to the sustainability manager at SCH and learned about the hospital’s biggest sources of carbon emissions. At the top: heating and power from natural gas. Next: emissions from commuting.
The third highest source of emissions? Anesthesiology. Hansen’s own department.
In the five years since she learned about her department’s outsized role in pumping greenhouse gasses into the atmosphere, Hansen dedicated her time to fixing the problem — teaching others and changing long-held habits in the anesthesiology world to make significant reductions in her hospital’s climate emissions.
Thanks to her efforts, the anesthesiology department at SCH cut its emissions by 87%, according to a paper published this summer. Currently, the number is at 90%, according to Hansen. The changes made on a departmental level cut SCH’s total emissions by 5-to-7%.
Hansen didn’t stop at SCH. She developed a consortium, Project Saving Our Planet to RedUce Carbon Emissions (SPRUCE) Forest, to spread the work to other pediatric hospitals. Eleven participating hospitals — national and international — cut their departments’ emissions since using Hansen’s techniques and teachings. She’s currently working on a plan for adult hospitals.
“Sometimes you meet an individual who is passionate about changing the world and not just changing the world for herself, but changing the world for everybody else,” Dr. Dan Low, an attending anesthesiologist at SCH and the chief medical officer of Seattle healthcare startup AdaptX, said about Hansen.
The problem
Hansen’s big question was: “How does healthcare impact climate change?” The answer, it turns out, is a lot. Especially if you’re an anesthesiologist.
For adults, most anesthesia is administered intravenously. Children, however, mostly don’t tolerate IVs, Hansen said. To put them to sleep, anesthesiologists rely on inhaled anesthesia pumped through facemasks, laryngeal masks, or breathing tubes. When the patient is asleep, they insert an IV. However, for children and adults alike, anesthesiologists usually use inhaled gasses to keep the patient under.
These gasses are the climate offenders in anesthesiology. Two of the most common gasses — nitrus oxide and desflurane — are big carbon offenders. Desflurane has a global warming potential (GWP) of 2,400 — which means it’s 2,400 times more potent than carbon. Using one bottle of desflurane is the equivalent of burning 880 pounds of coal. Nitrous oxide isn’t as potent (it has a 300 GWP) but it stays in the atmosphere for 114 years. SCH uses it all the time, so the overall impact is greater.
“No one was bold enough to think what she thought.”
The potency of the gasses was a chief concern for Hansen. Additionally, most of the gas doesn’t make it into the patient and instead hangs out in the building, then gets vented into the atmosphere. This wasted gas comes from “high flow” anesthesia practices. Common practice is to pump gasses at a fast rate. Yet, efficient and equally-effective ways of administering these gasses exist, they just weren’t being taught or used.
Hansen learned more about the problem. Then, she started fixing it.
“[Acting on my climate anxiety] helps me feel like I’m doing something with it instead of worrying about it,” said Hansen, who grew up in the Chicago suburbs and moved to Seattle in 2012.
The solution
According to Low, anesthesiologists have been using the same gasses for 50 to 60 years. Hansen’s first tack was to change behavior. She gradually cycled out of desflurane by educating people about it and then asking whether the department really needed to use it. In fact, it didn’t — less potent sevoflurane worked just as well.
“No one was bold enough to think what she thought,” Low said. “Everyone could see. Everyone had the same data points. No one made the moves.”
Next, she worked on cutting out nitrous oxide. Then, Hansen advocated for lower flow anesthesiology, the more-efficient way to administer gasses. She made the default setting on the anesthesia ventilators lower.
However, Hansen’s best and most-effective idea involved gamifying the system.
“How do people change their practice? How do we get anybody to do anything?’” Hansen said of her thought process. She pictured a leaderboard and prizes for the lowest emitter.
Together with Low, Hansen worked to enter her hospital’s data into AdaptX, the medical data tech startup. Soon, SCH’s anesthesiologists could see data about how much carbon they used, or didn’t use.
Having direct feedback changed behavior quickly. Hansen celebrated the anesthesiologists who cut the most emissions in email newsletters, then interviewed them about their strategies.
She then shared these strategies, her own methods, and the AdaptX tech with anesthesiology departments at other pediatric hospitals — that, in turn, cut their emissions significantly.
“She was able to take these tablets of stone that were accepted as ‘this is how you practice anesthesia’ and she said, ‘hey you don’t have to use it this way,’” Low said. “She managed to change everybody. Not just her, not just her friends. She managed to change everybody’s behavior.”
Hansen is proud of her work, but mostly she’s grateful for her colleagues who jumped at her ideas and changed their ways.
“They’re the ones who are changing the ways they take care of kids to be more environmentally friendly,” Hansen said. “They do such a good job and they take amazing care of these kids.”
One of the biggest highlights is that her own kids, ages 5 and 7, are proud of her. That helps, because in a lot of ways, she is doing this for them and for the world they’re going to inherit.
“It’s a lot of work,” Hansen said. “I’m really lucky that I can make a difference and that it’s important work that I’m passionate about, so when I feel really busy and tired, I feel motivated to keep going with it.”
