{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T12:04:41Z","timestamp":1790769881248,"version":"4.1.0"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intensive care units are resource-intensive clinical environments with substantial material and environmental impacts. This study evaluated whether clinician-led sustainability interventions implemented through established quality improvement methods could reduce resource use while maintaining explicit safety oversight.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a single-centre pre\u2013post quality improvement evaluation in a 34-bed tertiary intensive care unit in Singapore. Following baseline audits, multidisciplinary stakeholder engagement and pragmatic prioritization, three interventions were implemented: digitization of clinical competency documentation, stewardship of ventilator circuits during intrahospital transport, and replacement of conventional sharps containers with repurposed disinfectant canisters for arterial blood gas syringe disposal. Interventions were refined using Plan\u2013Do\u2013Study\u2013Act cycles; a structured process-redesign framework guided digitization, and Failure Modes and Effects Analysis informed risk mitigation for ventilator-circuit stewardship. Primary outcomes were changes in material use. Secondary outcomes included estimated environmental and cost impacts, staff acceptability and safety events identified through routine surveillance and incident reporting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Full digitization eliminated \u223c27\u00a0000 paper sheets annually. Ventilator-circuit use decreased by approximately three circuits per intubated admission, equivalent to an annualized reduction of 558 circuits. Repurposed canisters completely replaced 403 conventional sharps containers annually. These changes corresponded to an estimated annual reduction of \u223c866\u2009kg carbon dioxide equivalent. All 21 eligible respiratory therapists completed the circuit-stewardship survey, with favourable ratings for usability, preference, and perceived safety. Repurposed canisters were preferred over conventional sharps containers without a significant difference in perceived safety. No adverse events attributable to the revised workflows were detected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Clinician-led sustainability interventions integrated into established intensive care unit quality and safety \u00adprocesses were associated with measurable reductions in material use. Multidisciplinary prioritization, iterative testing, and intervention-specific risk assessment provide a transferable approach for implementing sustainability initiatives in \u00adcritical care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/intqhc\/mzag132","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T11:50:59Z","timestamp":1789127459000},"source":"Crossref","is-referenced-by-count":0,"title":["Implementing clinician-led sustainability interventions in a tertiary intensive care unit: a quality improvement evaluation"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4055-5222","authenticated-orcid":false,"given":"Wei Jun Dan","family":"Ong","sequence":"first","affiliation":[{"name":"Department of Respiratory Therapy, Ng Teng Fong General Hospital, National University Health System , Singapore,","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faheem Ahmed","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System , Singapore,","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woon Hean Keenan","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System , Singapore,","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence Ace","family":"Azul","sequence":"additional","affiliation":[{"name":"Department of Respiratory Therapy, Ng Teng Fong General Hospital, National University Health System , Singapore,","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9288-643X","authenticated-orcid":false,"given":"Amit","family":"Kansal","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System , Singapore,","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"2026093007515925600_mzag132-B1","doi-asserted-by":"publisher","first-page":"1847","DOI":"10.1016\/S0140-6736(24)01822-1","article-title":"The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action","volume":"404","author":"Romanello","year":"2024","journal-title":"Lancet"},{"key":"2026093007515925600_mzag132-B2","doi-asserted-by":"publisher","first-page":"e271","DOI":"10.1016\/S2542-5196(20)30121-2","article-title":"The environmental footprint of health care: a global assessment","volume":"4","author":"Lenzen","year":"2020","journal-title":"Lancet Planet Health"},{"key":"2026093007515925600_mzag132-B3","doi-asserted-by":"publisher","first-page":"1729","DOI":"10.1007\/s00134-024-07662-7","article-title":"Environmental sustainability in intensive care: the path forward. 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