Algorithm 3: Case Study 2


When faced with an opportunity to s ave hundreds of thousands of dollars a year and help reduce the emission of greenhouse gases, the decision is pretty easy. The trick, however, is finding those opportunities and then acting on them.

That's what Michael Cahalan, M.D., chair of the Department of Anesthesiology, did when he discovered a study that showed desflurane, the drug used almost exclusively in the OR since the early 1990s, costs more than $14 an hour, while the cost of an equivalent drug, isoflurane, had plummeted to just 53 cents an hour.

What resonated even more than the cost savings with the department's faculty and residents was the environmental impact. During a one–hour surgery, desflurane emits greenhouse gases equivalent to a car driven 235 miles, while isoflurane emits the equivalent of a car driven only 20 miles. Although patients wake up a bit more slowly from isoflurane, tapering the isoflurane dose appropriately or switching to desflurane at the end of each procedure solved that issue so that patient safety and comfort were equivalent with both drugs.


Why hadn't they switched sooner? Quite simply, they weren't looking. "If you don't care about what it costs, it's easy to use the more expensive drug," says Cahalan. "We need to think more carefully about which drugs we choose."

Cahalan's careful thinking has paid off. The green anesthesia program saved the hospital $300,000 on anesthetic drugs in 2011 and reduced greenhouse gas emissions by 25 percent. Meanwhile, Cahalan’s department is making the most of its UHPP windfall, using some of the reward money to upgrade computers and train residents.