Green initiatives in Intensive Care Units (ICUs) increasingly focus on reducing the environmental footprint of routine care. Common measures include lowering glove use, replacing absorption pads with towels and shifting from disposable clothing to washable alternatives. While such actions are relatively simple to introduce, sustaining them requires structured monitoring. ICU teams need reliable information on product use that reflects clinical activity rather than raw purchasing volumes alone. In many hospitals, procurement, clinical activity and environmental data are stored in separate systems, limiting their usefulness for operational decision-making. A dashboard known as GERDA, the Green ERasmus MC Data Assistant, was developed to address this gap by linking procurement data with patient activity and environmental impact indicators, providing ICU green teams with a consolidated and interpretable overview.
Integrating Procurement, Clinical and Environmental Data
GERDA was developed in 2024 to connect three distinct data streams. Procurement data are retrieved via an internal Health Data Platform from an Oracle Purchasing system. These records include product name and quantity, department cost owner, order date and supplier and manufacturer details. For the ICU, procurement data account for 99.89% of all purchased medical products. Items are organised using the Article Object Classification system, which structures products hierarchically from broad categories to specific items.
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Clinical data are also sourced from the Health Data Platform and originate from the hospital electronic health record system, ChipSoft HiX version 6.2. These data provide the number of ICU patient admission days. Linking product volumes to admission days enables calculation of product use per patient day, allowing changes in usage to be interpreted independently of fluctuations in patient numbers.
Environmental data are stored separately in a manually maintained Excel database. This database contains environmental impact factors per kilogram of product for the production phase, including CO2-equivalent emissions, land use and water use. Impact factors were derived from existing work in comparable product categories and clinical contexts, supplemented with available life cycle analyses. Not all products are covered, as some lack reliable mass or environmental impact data. Both the database and GERDA are designed to be updated as additional information becomes available, including data for reusable pulse oximeters and blood pressure cuffs.
Dashboard Design for Practical ICU Use
GERDA was built using Power BI and designed to support everyday use by ICU green teams. Users can filter data by time period or search for individual products. The hierarchical product classification enables navigation from broad groups, such as disposables, to specific items like a particular glove type. The dashboard includes both single-use and reusable options for pulse oximeters and blood pressure cuffs, while reusable linen is excluded.
Visualisations are structured to highlight relevant patterns. Product counts are displayed in descending bar charts to identify high-volume items, while timelines show trends over time. A key metric is product use per patient admission day, which allows comparisons between periods while accounting for differences in ICU activity. For products with available environmental data, the dashboard also presents total weight and estimates of CO2-equivalent emissions, water use and land use.
Underlying calculations translate procurement data into interpretable indicators. Product use is calculated as the number of items divided by patient admission days. Total mass is derived by multiplying the number of items by mass per item. Environmental impacts are then calculated by applying category-specific impact factors per kilogram to the total mass. These steps convert purchasing data into metrics that can be monitored over time and communicated to ICU healthcare professionals.
Usability was refined through iterative testing with green team members. The layout supports intuitive interpretation and can be displayed on television screens within the ICU, facilitating communication of results and progress to staff.
Monitoring Change and Identifying Data Gaps
GERDA supports goal setting and progress monitoring for specific interventions. An example focuses on non-sterile glove use in an ICU over the period from 2019 to 2023. In 2019, total glove use was 1,500,900, corresponding to 108 gloves per patient day. By 2023, usage declined to 1,450,600 gloves, or 92 gloves per patient day. This represents a 15% reduction in glove use. The change coincided with awareness initiatives led by the ICU green team, including the No risk, no glove campaign introduced towards the end of 2022.
Beyond individual products, the dashboard is intended to help teams identify high-impact items, define targets, track trends and share outcomes with ICU staff. Its reliance on routinely collected hospital data is presented as a basis for scalability to other departments and institutions.
The development process also highlights limitations related to data availability. Incomplete product-level environmental information increases reliance on manual data collection. Improving transparency from suppliers and manufacturers, including provision of product weight and life cycle analysis data, is identified as a way to strengthen accuracy. Shared understanding of data definitions and metrics, such as product use per patient day, is also emphasised. An open-access global database, MedZero from the Lancet, is expected in 2026 and is anticipated to contribute additional data to support such efforts.
GERDA combines procurement records, ICU admission data and environmental impact factors to provide green teams with a structured view of product use and associated environmental metrics. Normalising usage per patient day allows changes to be interpreted in the context of clinical activity, while visualisations support monitoring and communication. The reduction in glove use illustrates how awareness initiatives can be tracked using consistent indicators over several years. The dashboard represents a scalable approach, while highlighting the need for improved product-level environmental data to support sustainability efforts in critical care settings.
Source: Intensive Care Medicine
Image Credit: iStock
