{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T01:30:40Z","timestamp":1790731840427,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Healthcare contributes 4%\u20135% to global carbon emissions. The intensive care unit (ICU) produces three times more carbon emissions per patient\u2010day than that of the general ward. Over\u2010ordering of laboratory investigations contributes to the carbon footprint in the ICU.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the carbon footprint arising from laboratory investigations in the ICU over an 8\u2010month period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>We conducted a retrospective single\u2010centre clinical practice baseline evaluation within a Sustainability in Quality Improvement (SusQI) project in the Surgical ICU in Singapore General Hospital. The number and types of laboratory investigations ordered for all patients admitted from May to December 2023 were extracted from the electronic medical records system. Existing process\u2010based Life Cycle Assessment (LCA) data were used to determine the carbon footprint of the investigations ordered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 285 patients were admitted to the ICU, amounting to 1464 patient\u2010days. An average of 12.3 investigations were ordered per patient\u2010day. The total carbon emissions over this period were 1560\u2009kg carbon dioxide equivalent (kgCO\n                      <jats:sub>2<\/jats:sub>\n                      e) or an average of 1.07 kgCO\n                      <jats:sub>2<\/jats:sub>\n                      e per patient\u2010day. The most common investigation ordered was urea, electrolytes and creatinine (UECr), while the liver panel \u00b1 gamma\u2010glutamyl transpeptidase (LFT\u2009\u00b1\u2009GGT) generated the highest total carbon emissions (337.7 kgCO\n                      <jats:sub>2<\/jats:sub>\n                      e). A total of 20.7% of investigations lacked available LCA data.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study quantified the carbon footprint contributed by laboratory investigations in ICU from available LCA data. Although laboratory investigations contribute a small proportion of the total carbon footprint in the ICU, it is an area that can be targeted to reduce unnecessary carbon footprint as part of a holistic approach to environmental sustainability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>This study highlights the environmental impact of laboratory investigations. Clinicians should be aware of this fact and avoid unnecessary laboratory investigations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nicc.70145","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T10:27:37Z","timestamp":1754908057000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Carbon Footprint of Laboratory Testing in an Intensive Care Unit: Baseline Evaluation for a Quality Improvement Project"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8395-8964","authenticated-orcid":false,"given":"Siting","family":"Goh","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Perioperative Medicine Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu Heng Julian","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Perioperative Medicine Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sui An","family":"Lie","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Perioperative Medicine Singapore General Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,11]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01859-7"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1088\/1748-9326\/ab19e1"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(20)30271-0"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(20)30121-2"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-021-06455-6"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.15671"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00063-023-01039-2"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11367-021-01998-8"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1441-2772(23)00970-5"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2014.06.015"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-022-06940-6"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2023-002316"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.50583"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2003.11.005"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/nicc.13092"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2044.2001.01716.x"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vhri.2019.09.006"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.21037\/atm.2017.02.04"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-020-00981-5"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiochem.2018.01.024"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc12628"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccrj.2023.05.004"},{"issue":"1","key":"e_1_2_13_24_1","first-page":"3","article-title":"Reducing the Environmental Impact of Clinical Laboratories","volume":"38","author":"Lopez J. 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