Sustainability in the OR – eNewsletter
ISSUE 12 – 2026
Sustainability Best Practice Alerts (BPAs)
CHANGE is difficult, both in life and in professional practice patterns. Knowing the right thing to do does not always translate to changing habits. All of the previous SITOR e-newsletters have been informational and motivational for the purpose of instilling change into clinical practices for the betterment of our environment. To optimize implementation of these sustainability practice changes, Electronic Medical Records (EMRs) can play a key role. BPAs in Epic EMRs, or the equivalent in other EMRs, can be created by software engineers to remind providers in real time to implement sustainability practice changes.Here are three suggested BPAs that can be integrated into an EMR:
“Fresh gas flow is exceeding 1.0 L/M. Reduce fresh gas flow, as appropriate”
Designed to remind providers to reduce total fresh gas flow (FGF) when delivering > 1 L/M during anesthesia maintenance. It should trigger when detecting volatile agent and FGF > 1.0 L/M. The software can start checking soon after induction and recheck at selected intervals to make sure reduced flows continue.
“Consider Sevoflurane. GWP is much lower than DES and N₂O”
Alerts providers who are using DES or N₂O to switch to SEVO, the volatile agent with the lowest GWP. Eliminating DES from the hospital formulary is still suggested as mentioned in a previous SITOR e-newsletter. Also, decommissioning of the hospital’s N₂O pipeline in exchange for N₂O e-cylinders should be considered due to not so uncommon system leaks.
“Consider switching to TIVA or adding a propofol infusion (lower carbon footprint anesthetic)”
Designed to steer providers away from pure volatile agent anesthetics. This would be a one-time alert for general anesthesia cases only. It would trigger if volatile agent is detected and no propofol infusion is detected.
Today's Key Takeaway
Real-time EMR alerts can drastically improve adherence to sustainability practice changes.
Connect & Learn More
Adam Fischler, M.D.
Integrated Anesthesia Associates
Associate Clinical Professor, Department of Anesthesiology, UCONN Health
Chair, OR Sustainability Committee, UCONN Health
iaapartners.com/sustainability
adam.fischler@iaapartners.com
860-679-4824
APSF Low-Flow Anesthesia Course
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Complete this hands-on low-flow anesthesia course (if you haven’t done so already). Earn CMEs through APSF.org. This APSF module will greatly assist you in becoming much more comfortable with the concepts of safe delivery of low-flow anesthesia.
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As has been said by many individuals in various ways:
“We did not inherit this earth; we are borrowing it from our children.”
Please use the contact information above to get in touch. I’d love to hear from you.
