Photo: Dr. Karina Spoyalo (Left) and Dr. Janet Simons (Right)
Have you ever stopped to wonder whether all lab tests ordered for patients are absolutely necessary?
For Dr. Janet Simons, Co-Medical Director, Clinical Informatics, and Internal Medicine Physician at Providence Health Care (PHC), this question has been the focus of much of her work at St. Paul's Hospital (SPH).
“As a medical biochemist, lab medicine is an integral aspect of my work," says Janet. “So I'm constantly questioning, with both hospitalized patients and outpatients, 'do we always need all of the lab tests that are ordered on our patients?'"
She says at SPH, the norm has been to collect blood work from patients every morning, which can be unpleasant for the patient, and is often unimportant for their medical care plan.
“So by inserting a prompt in the system for physicians to choose whether or not to reorder blood work, we reduced the amount of blood we were collecting each day by approximately 30 percent," she says.
Each blood test requires several physical components, including the needle, plastic tubing, sterile coating and paper labels. Due to staffing and supply chain issues caused by the pandemic, some of these are now imported, resulting in additional emissions from shipping.
“You can imagine the environmental impact not only from the amount of waste produced, but also from planes flying across the globe to deliver supplies," says Janet. “Decreasing the amount of blood and other lab tests is a relatively simple, yet highly impactful, means of reducing the carbon footprint of our healthcare system."
The UBC Planetary Healthcare Lab, led by Dr. Andrea MacNeill, creates innovative solutions to tackle the growing environmental effects of the B.C. healthcare system. Dr. Karina Spoyalo, General Surgery Resident at Vancouver General Hospital (VGH) and member of the lab, has been leading a study around eliminating excessive blood work.
“We've been focusing specifically on general surgery inpatients, and we wanted to see how often we've been collecting non-essential blood work," says Karina. “On average, nearly one in five patients in Canada undergo some form of unnecessary blood testing, and this is due to various factors, but ultimately it stems from a lack of standardization."
Their team found that 76 percent of uncomplicated general surgery patients at VGH were receiving unnecessary blood work. They also developed a set of recommendations to guide the appropriate use of lab testing, and avoid unnecessary investigations into patient presentations.
“We calculated the cost of the excess testing to be around $10,000 [over one year], which may not sound like a lot at first, but this is one small subset of patients, in one single division of surgery, at one hospital, in just one year," Karina says.
She says they're also trying to measure the total amount of carbon emissions generated during the lifecycle of each single consumable (a syringe, for example), to accurately determine the environmental impact.
“To me, this is the most interesting aspect, but it's also the most granular. We have to multiply the weight of each consumable by its emission factor, and then consider where it was produced, how it was transported to VGH and where it was discarded/recycled."
Quantifying all the carbon dioxide equivalents produced from each lab test helps demonstrate the positive impact of laboratory stewardship programs on the health of individual patients, and global health communities.
Thanks to curious minds like those of Janet and Karina, we'll be a step closer towards a more environmentally sustainable healthcare system.
