ArticleBMJ open quality2026
From patient to planet: integrating climate impact into a hospital medicine initiative reducing blood urea nitrogen testing.
Article in BMJ open quality, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPursuing climate-conscious care has become a key focus of quality improvement (QI) efforts. Hospitals across Alberta, Canada, implemented a multicomponent intervention to reduce unnecessary blood urea nitrogen (BUN) testing. This study evaluated the broader environmental impact of the intervention across multiple hospital medicine settings.
methodsUsing a pre-post study design, monthly BUN test counts were compared before and after implementing the initiative across six hospital medicine wards to calculate percentage reductions. A secondary analysis assessed the initiative's environmental impact using the Lab Wisely Carbon Calculator, which converted reduced BUN testing into equivalent travel distances. Avoided carbon dioxide (CO₂) emissions were estimated at 32.1 g/test and tree equivalents were calculated using an annual absorption rate of 21.77 kg CO₂/tree.
resultsHospitals showed monthly reductions in unnecessary BUN testing between 51% and 95%, saving an estimated 5101.92 km of travel and avoiding 169.39 kg of CO₂ emissions monthly, equivalent to planting about 93 trees annually. The climate impact varied by hospital, reflecting differences in the intervention strategies used.
conclusionsIntegrating environmental metrics into QI initiatives offers a strategic path to climate-conscious care, promoting sustainability alongside fiscal responsibility and resource efficiency.
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