Sustainable cardiac services-From the catheterization laboratory to the operating room and beyond

Economic and environmental sustainability are essential to maintaining delivery of high quality healthcare. Numerous medical innovations in recent times demonstrate that modern cardiovascular care is in quick and constant flux. Examples are the novel minimally-invasive interventions, improved disease management in heart failure, innovative methods in atrial fibrillation ablation or the personalized medicine approach in cardiomyopathies. Healthcare's predilection, however, for a single use oil-based plastics and metalware are unsustainable in the long run (even considering a 50 year time frame, let alone 1000 years). Sustainability is not an isolated competency of clinical practice, but instead transcends such seemingly disparate fields such as: finance, environment, security, resilience, staffing, efficiency, effectiveness, patient centred care and business ethics. Healthcare providers tend to be isolated in domains within hospitals such as the paediatric catherization (cath) laboratory (lab) and the operating room, with a limited understanding of the full process, complexity and broader implications of what we do daily and How these practices impact the environment. Consider the following simple sustainability questions: What are the financial costs of a routine angiogram for a child with Tetralogy of Fallot? How much waste per day is produced by the cath lab? Is it possible to use reusable instead of single use medical devices? In this paper we explore the: (a) incremental sustainability changes; (b) opportunities and barriers for sustainability initiatives within the paediatric cath lab; (c) discuss the transformational changes aimed at broader concerns about unsustainable cardiovascular care; and, (d) provide a roadmap for sustainability education, training and research. Sustainable solutions must enable pediatric cardiovascular clinicians to not to make sound clinical decisions and provide safer procedures, but also address the growing economic and environmental challenges faced by today's healthcare systems. Crown Copyright (C) 2011 Published by Elsevier Ireland Ltd. All rights reserved.