A Multimodal Quality Improvement Approach to Reduce Sevoflurane Consumption and Greenhouse Gas Emissions in an Academic Health System

TL;DR

A hospital reduced sevoflurane use and greenhouse gas emissions through education, workflow changes, and electronic alerts, saving costs and the environment.

Contribution

A multimodal quality improvement initiative integrating education, workflow optimization, and EHR alerts to reduce sevoflurane use in healthcare.

Findings

The proportion of cases with low fresh gas flow increased from 18.2% to 55.0% after interventions.

Annual sevoflurane use dropped by 35,277 L, reducing CO₂e emissions by 45,000 kg and saving $38,000.

Cases with high fresh gas flow decreased from 52.7% to 14.8% following the initiative.

Abstract

Introduction

Volatile anesthetics are major contributors to healthcare-related greenhouse gas (GHG) emissions. After eliminating desflurane from our formulary, we implemented a multimodal quality improvement (QI) initiative to reduce sevoflurane use by adopting low fresh gas flow (FGF) practices.

Methods

This QI project was conducted at two campuses of the University of Minnesota Medical Center (41 operating rooms, ~1,400 cases/month). Interventions between May 2024 and February 2025 included provider education, standardized workflows, monthly data feedback, and anelectronic health record (EHR) best practice alert (BPA) prompting lower FGF use. FGF metrics were derived from intraoperative data with specific inclusion and exclusion criteria, while sevoflurane volume and cost data were obtained directly from SlicerDicer and pharmacy purchase records. Outcomes were analyzed using control charts and two-sample t-tests comparing pre-intervention (January 2023-April 2024) and post-intervention (May 2024-June 2025) periods.

Results

A total of 42,416 general anesthetic cases using sevoflurane met the inclusion criteria. The proportion of cases with average FGF < 2 L/min during the maintenance phase increased from 18.2% to 55.0% (3,886/21,122; 10,323/18,775) (p < 0.001), while those never below 2 L/min decreased from 52.7% to 14.8% (11,128/21,122; 2,812/18,775) (p < 0.001). Mean monthly sevoflurane use declined from 9,785 L to 7,475 L, corresponding to an annual reduction of 35,277 L (approximately 45,000 kg CO₂e) and a net cost savings of approximately $38,000.

Conclusions

At a single academic institution, a multimodal, data-driven QI initiative integrating staff education, workflow optimization, the EHR, and low-flow anesthesia significantly reduced sevoflurane consumption, resulting in net cost savings and a positive environmental impact.

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