{
  "abstract": "Objective Quality improvement (QI) practices and scholarship are increasingly concerned with environmental sustainability given the negative health outcomes caused by the ecological crisis, as well as the environmental impacts of healthcare delivery itself. A core component of QI activities is measuring change. How sustainability metrics have been used in QI is unclear. We conducted a scoping review of metrics used in published sustainability-focused QI initiatives.Data sources MEDLINE, EMBASE, CINAHL and Scopus from 2000 to 2023.Eligibility criteria Published healthcare QI initiatives intended to address environmental sustainability with at least one quantitative sustainability metric.Data analysis Publication, study, measurement and QI intervention characteristics were charted from included studies. Data items were synthesised and presented narratively as well as quantitatively.Results We screened 6294 studies and included 90 full-text publications. The studies were published from 2000 to 2023, with the majority (61%, 55/90) published since 2020. Publications originated from a wide range of clinical disciplines with most QI projects situated in the inpatient setting (78%, 70/90). Environmental sustainability metrics were subcategorised into activity data and environmental impact indicators. Some papers included more than one category of activity data, with the most common being cost (88%, 79/90), hospital waste (52%, 47/90), anaesthetic gases (49%, 44/90), disposable use (24%, 22/90) and distance travelled (14%, 13/90). Fewer publications included environmental impact indicators, with global warming potential dominating this category (53%, 48/90).Discussion There is a need to align QI efforts with environmental sustainability. However, there is limited guidance specific to healthcare QI on how to measure environmental impacts of these efforts. This review illuminates that sustainability-focused QI efforts to date have used a relatively narrow set of sustainability metrics. QI scholars and practitioners can benefit from further education, measurement frameworks and guidelines to effectively incorporate environmental sustainability metrics into QI efforts.",
  "authors": [
    {
      "affiliations": [
        "Department of Surgery, University of Toronto, Toronto, Ontario, Canada",
        "Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Colin Sue-Chue-Lam"
    },
    {
      "affiliations": [
        "Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Sezgi Yanikomeroglu"
    },
    {
      "affiliations": [
        "Rush University, Chicago, Illinois, USA"
      ],
      "name": "Darius Baginskis"
    },
    {
      "affiliations": [
        "Department of Surgery, University of Toronto, Toronto, Ontario, Canada",
        "Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Doulia M Hamad"
    },
    {
      "affiliations": [
        "Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada",
        "Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada",
        "Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada",
        "Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Brian M Wong"
    },
    {
      "affiliations": [
        "Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Nicole Simms"
    },
    {
      "affiliations": [
        "Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Karen B Born"
    }
  ],
  "title": "Metrics used in quality improvement publications addressing environmental sustainability in healthcare: a scoping review",
  "uid": "8f566e49-820f-5329-b003-662e3c4eda4d"
}