Stanford residents aim to make clinics more sustainable


The US healthcare system is responsible for almost 9% of the country’s total carbon emissions. These emissions are part of a larger climate crisis that is harming human health, according to recent reports from the Lancet Countdown on Health and Climate Change and the World Health Organization.

Last summer and fall, a cohort of Stanford Medicine residents saw this reality firsthand as they treated patients whose health was affected by wildfires, among other climate-related health issues.

“The link between climate and health care has been front and center for many of us, as we have seen patients affected by heat and smoke, and we recognize that the health care industry contributes significantly to climate change,” said dermatology resident Paige. Wolstencroft, MD.

So when this cohort of Stanford dermatology residents had the opportunity to participate in a quality improvement project — one that operates within a framework used to systematically improve an organization’s processes and systems. The idea was to improve an aspect of their medical practice in the spring of 2021, they focused on sustainability.

Wolstencroft and colleagues from the Department of Anesthesiology and the Stanford Resident Safety Council developed a project focused on reducing waste from trays typically used during skin biopsies, under the mentorship of Bernice Kwong, MD.

Their efforts have already caught the attention of professors at the School of Medicine who have advocated for more climate-friendly practices.

“As physicians, we have a moral and ethical obligation to reduce our carbon footprint,” said Barbara Erny, MD, adjunct clinical associate professor and proponent of integrating climate change education at all levels of training of doctors. “The work that Dr. Wolstencroft and her fellow residents are doing demonstrates that we can all make a difference by analyzing the way we practice medicine and implementing change in the clinic and the hospital.”

I spoke with Wolstencroft about the project and how others can apply quality improvement principles to “green” their medical practices. This conversation has been edited for clarity and length.

How did you decide which aspect of your practice to focus on?

We knew we wanted to create a project that would universally engage residents and be both sustainable and scalable for all of our clinical sites. Given the frequency with which skin biopsies are performed, this seemed like a natural place to start. The potential impact of reducing biopsy tray waste cannot be emphasized enough. Through our initial week-long waste audit, we determined that 46 skin biopsies were performed, leading to a conservative estimate of 2,392 skin biopsies performed annually by residents of our dermatology program alone.

How much waste did these biopsies generate?

We observed great variability between clinical sites with respect to the materials used as part of the skin biopsy tray configuration, as well as the total amount of waste. We defined waste as any item on a skin biopsy tray that has been opened and unused, and therefore discarded at the end of the procedure. Using this definition, we found that 84% of trays contained at least one wasted item, and the average number of wasted supplies per tray was 7.2. Some items – including gauze – were wasted with greater frequency and volume than other supplies. This made it possible to target our intervention.

How did you go about translating this observation into action?

We realized that we would need individualized interventions for each clinical site, given the differences in supplies used, configuration, and waste produced at different clinical sites.

And we recognized the importance of involving all members of the clinic team. We started with the skin cancer clinics and are extremely grateful to the entire clinical team and administrative staff at this site who have worked with us to implement changes to optimize and define what is needed on a biopsy tray.

Through this collaboration, we have replaced the thick pads covering the biopsy trays with thinner paper and ordered smaller skin markers that are not individually wrapped. We also created a workflow for biopsy tray setup that minimizes the number of items on the tray at the start of a skin biopsy. We are conducting another waste audit to quantify the impact of our efforts.

Read it original questions and answers published on the Stanford Center for Innovation in Global Health website. Learn more about healthcare sustainability on the CIGH webpage, Sustainability Resources for Medical Providers.

Photo by Sakepaint


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