The carbon footprint of blood tests and unnecessary blood work in Canada

Abstract

Objective: To characterise the extent of unnecessary care in general surgery inpatients using a triple bottom line approach.

Design: Patients with uncomplicated acute surgical conditions were retrospectively evaluated for unnecessary bloodwork according to the triple bottom line, quantifying the impacts on patients, healthcare costs and greenhouse gas emissions. The carbon footprint of common laboratory investigations was estimated using PAS2050 methodology, including emissions generated from the production, transport, processing and disposal of consumable goods and reagents.

Setting: Single-centre tertiary care hospital.

Participants: Patients admitted with acute uncomplicated appendicitis, cholecystitis, choledocholithiasis, gallstone pancreatitis and adhesive small bowel obstruction were included in the study. 304 patients met inclusion criteria and 83 were randomly selected for in-depth chart review.

Main outcome measures: In each patient population, the extent of over-investigation was determined by comparing ordered laboratory investigations against previously developed consensus recommendations. The quantity of unnecessary bloodwork was measured by number of phlebotomies, tests and blood volume in addition to healthcare costs and greenhouse gas emissions.

Results: 76% (63/83) of evaluated patients underwent unnecessary bloodwork resulting in a mean of 1.84 phlebotomies, 4.4 blood vials, 16.5 tests and 18 mL of blood loss per patient. The hospital and environmental cost of these unnecessary activities was $C5235 and 61 kg CO2e (974 g CO2e per person), respectively. The carbon footprint of a common set of investigations (complete blood count, differential, creatinine, urea, sodium, potassium) was 332 g CO2e. Adding a liver panel (liver enzymes, bilirubin, albumin, international normalised ratio/partial thromboplastin time) resulted in an additional 462 g CO2e.

Conclusions: We found considerable overuse of laboratory investigations among general surgery patients admitted with uncomplicated acute surgical conditions resulting in unnecessary burden to patients, hospitals and the environment. This study identifies an opportunity for resource stewardship and exemplifies a comprehensive approach to quality improvement.

Research highlights

• "Unnecessary diagnostics within healthcare are prevalent, and contribute to a considerable burden of avoidable resource use and cascading down-stream investigations."
• "Using a triple bottom line approach, our study estimates the impacts of unnecessary bloodwork on general surgery inpatients, hospital costs and the environment."
• "The carbon footprint of twenty commonly ordered laboratory investigations and panels was calculated, providing a framework for future carbon cost calculation across all medical specialties."
  
• "The carbon footprint of a single phlebotomy was estimated at 150 g CO2e, while processing a green, blue, purple and gold vial with all of their respective tests produced 689 g, 66 g, 39 g and 77 g of CO2e, respectively."
  
• "Eliminating healthcare activities that contribute no clinical value is a strategic target for decarbonising the health sector, with co-benefits of avoiding patient harm and accruing cost savings."

Methods & Results

For a complete summary of this data source and to see reported environmental impact values for studied products and activities, explore the HealthcareLCA Database.

Citation

Spoyalo K, Lalande A, Rizan C, Park S, Simons J, Dawe P, Brown CJ, Lillywhite R, MacNeill AJ. Patient, hospital and environmental costs of unnecessary bloodwork: capturing the triple bottom line of inappropriate care in general surgery patients. BMJ Open Quality. 2023 Jul 1;12(3):e002316.