Reducing use of desflurane in the anaesthetic department: A controlled interrupted time series analysis

Desflurane is a potent and expensive greenhouse gas. Reducing its use is a global priority. This anaesthetist-led quality improvement project involved educational, motivational and system-change initiatives implemented in the anaesthesia department of Bankstown-Lidcombe Hospital (BLH) (September 2021–March 2024), with the aim of reducing desflurane consumption. A quasi-experimental interrupted time series design with control site was employed to estimate changes in usage, greenhouse gas emissions and financial cost of anaesthetic agents per 100 surgeries. Prior to intervention, use of desflurane at BLH was stable. During and after intervention, a significant downward trend in desflurane use was observed, reducing by an average of 0.1 units (1 unit = 1 bottle) per month per 100 surgeries from September 2021 onwards (95% confidence interval (CI) –0.21 to –0.01, P = 0.035). The intervention, while not directly targeting sevoflurane use, was similarly associated with a downward trend in sevoflurane usage of an average of 0.5 units per month per 100 surgeries from September 2021 onwards (95% CI –189.74 kg to –10.43 kg, P = 0.004). No significant changes in use of desflurane or sevoflurane were observed at the control site, although use of both agents declined slightly over the study period. Estimated CO₂ equivalent (CO₂e) emissions were reduced by an average of 124.7 kg per month per 100 surgeries from September 2021 onwards (95% CI –223.3 kg to –26.1 kg, P = 0.018). Average monthly cost per 100 surgeries at BLH reduced by AU$100.34 per month (95% CI –AU$162.58 to –AU$38.10, P = 0.003). There were no changes in CO₂e emissions or costs at the control site. A clinician-led intervention highlights the importance of creating opportunity and motivation for change amongst staff as well as ongoing education, advocacy and engagement with department and executive to achieve positive environmental and financial outcomes.