Western Australia (WA) Health is the largest government entity in WA. With over 57000 staff employed across the state to deliver public health care, WA Health managed more than 1.1 million presentations to their emergency departments, over 605,000 admissions to hospitals, and performed more than 65,000 elective surgeries, in the 2022/23 financial year alone. WA Health has worked diligently to implement sustainability in their various health service providers.

The Problem

Internationally, health is recognised as having a significant carbon footprint and a recent analysis found WA Health to be responsible for a total of 8% of Western Australia's total emissions. Desflurane is a commonly used inhalational general anaesthetic agent, and it is also a potent greenhouse gas, with a global warming potential 2540 times that of carbon dioxide (CO2). It is recognised as an area for healthcare carbon emission improvement. Since 2019, there has been a clinician-led effort to decrease the use of desflurane within anaesthetic departments across WA Health. However, it was recognised that these changes were made through individual actions and could be reversed, so WA Health acknowledged the need to delist desflurane from both paediatric and adult Statewide Medicine Formularies (SMF) from a system level.

Goals:

• Leadership and sustainable thinking - commit to, and act towards, achieving ambitious net zero targets for WA Health by 2040
• Collaboration and systems approach - develop a model of governance for clinical excellence in sustainable healthcare through measurement reporting, and benchmarking of key indicators
• Learning and enabling environments - allocate resources to build knowledge and capacity across the health workforce to support the delivery of sustainable healthcare

The Process:

WA Health identified 5 significant phases in implementing the project to delist desflurane from paediatric and adult SMFs in Western Australia.

1. Research and scoping: Research was conducted to focus on the dangers of desflurane on the climate, and the benefits of changing to lower carbon anaesthetic agents. Data was also collected to target 'hot spots' within the WA health system.
2. Education and awareness raising: WA Health started a clinician-led movement to build awareness and educate individuals, departments, and health services on the harms of desflurane on the climate.
3. Advocacy and consultation: Individuals, departments, and hospitals were encouraged to make commitments to stop using desflurane through internal voting and actions from leading hospitals. This led to widespread support and a decreased used of desflurane across the WA Health system was observed
4. Ongoing monitoring and education: Purchasing patterns of desflurane across WA Health hospitals were observed by the Green Theatres Network and tailored actions were implemented for the sites that needed support.
5. System level action: The change was embedded across the system by involving the Department of Health's Sustainable Development Unit who supported clinicians in removing desflurane from clinical use across the state. The Western Australian Therapeutics Advisory Group (WATAG) received a comprehensive submission which requested the removal of desflurane from the SMF.

Outcome:

Following support from WATAG and the Western Australian Drug Evaluation Panel (WADEP), desflurane was delisted from the WA SMF in August 2023. As a result, desflurane will no longer be available for purchase and use through clinics and hospitals. The project has demonstrated the WA health system's commitment to reducing their environmental impact and delivering sustainable healthcare to its population. In 2023, the project was also nominated as a finalist for the category of Excellence in Sustainability in the WA Health Excellence Awards, 2023.

WA Health Awards 2023 - Sustainability finalist - removal of desflurane from the state-wide medicines formulary

This full case study is available to GGHH members via GGHH Connect

Congratulations Western Australia Health! Thank you for your sustainable healthcare leadership!