Implementing a Clinical Decision Support Tool to Reduce Operating Room Anesthetic Fresh Gas Flow: A Resident-Led, Sustainability-Focused Quality Improvement Initiative.

Background Lowering fresh gas flow (FGF) can help decrease the carbon footprint of the operating room as FGF levels act as an indirect measure of anesthetic gas waste. Objective The aim of this quality improvement project was to reduce clinician FGF during general anesthesia with clinical decision support (CDS) tools within the electronic health record (EHR) at a single institution. Methods A non-interruptive alert to reduce FGF was coded into the anesthesia intraoperative EHR workspace to alert whenever the 10-minute average FGF exceeded 1 L/min. It was targeted at anesthesia residents, attendings, and certified registered nurse anesthetists at a single US large academic level 1 trauma center. The number of general anesthesia cases with a target FGF of ≤2 L/min and the amount of sevoflurane (L/hr) was tracked on an individual and institutional basis. Results Following CDS implementation from July 2023 through July 2024, 2677 of 4573 (58.5%) had a mean FGF ≤2 L/min, demonstrating a 116.7% increase from our institution's baseline of 27.0% (1200 of 4446 cases) from July 2022 to June 2023, corresponding to a sevoflurane usage reduction of 36.7%. Conclusions Implementing a non-interruptive alert in the EHR altered institution-level behaviors to reduce environmentally harmful anesthetic gas emissions.