The VA Ann Arbor Healthcare System initiative has significantly reduced waste and environmental impacts while saving costs associated with pulmonary function testing (PFT).
The facility implemented a new standard operating procedure (SOP) for reusing albuterol inhaler, reducing inhaler usage by 91.1%, resulting in cost savings of over $46,000 within six months.
Inhalers containing hydrofluorocarbon propellants contribute significantly to greenhouse gas emissions, using Medicare inhalers (MDIs) where Medicare inhalers (MDIs) generate more than 1.1 million tonnes of community for Medicare and Medicaid patients each year. Albuterol inhalers alone account for 60% of these prescriptions.
In November 2023, the VA Ann Arbor Healthcare System gathered an interdisciplinary task force, including respiratory care, pharmacy, infection control and patient safety representatives, to assess the use of Albuterol and explore ways to reduce emissions and costs. The hospital implemented a new protocol in December 2023. Each PFT room was requested to use a single shared albuterol inhaler that was stored in a drawer and sanitized during use. A new spacer device with one-way valve was provided to ensure safety for each patient.
Changes made by the task force showed immediate results.
Prior to the new SOP (January-December 2023), PFT Lab used 117.7 inhalers per month, incurring an estimated cost of 1,494.4.4 kg, $8,709.70 per month. $752.53 a month. If bronchodilator testing increased by 20.7%, the initiative resulted in 624 fewer inhalers used, avoiding a joint emission of 7,924.8 kg.
“This initiative shows that small, practical changes can have a major impact,” says Alexander Rabin, pulmonary scientist at the VA Ann Arbor Healthcare System and lead author of the study. “By dramatically reducing unnecessary inhalation waste, it not only reduces environmental footprints, but also frees up resources that can be redirected towards essential services for veterans.”
Patient safety was not affected by new changes. Each patient receives a new spacer device, eliminating the risk of cross-contamination. No device-related infectious diseases have been reported between January and June 2024.
The initiative is consistent with global efforts to reduce healthcare-related emissions, providing a model for other VA and non-VA hospitals to adopt similar cost-cutting and environmentally friendly strategies. Further research is recommended for expanding the meter-dose inhaler recycling program and moving to propellant-free inhalers.
The success of this project will underscore the potential for policy changes for healthcare facilities across the country, reducing both financial and environmental burdens while maintaining high standards of patient care.
