As Singapore advances towards its net zero ambitions, clinicians like Dr Jo-Anne Yeo are leading the way. At Changi General Hospital (CGH), Dr Yeo and her team spearheaded a quiet but transformative shift: replacing intravenous (IV) paracetamol with oral paracetamol in elective surgeries. The result? A substantial reduction in carbon emissions, significant cost savings, and the preservation of high-quality patient care.
The Challenge
IV paracetamol is widely used in elective surgeries for its perceived faster onset, ease of administration and presumed reliability over oral alternatives. But it also comes with a hidden environmental cost – nearly 10 times the carbon footprint of its oral counterpart. It’s also significantly more expensive and generates large amounts of plastic waste.
The Approach
In October 2018, Dr Yeo introduced a new care pathway at CGH. Patients would receive1g of oral paracetamol in the Pre-Anaesthetic Clinic, with 100ml of water 30–60 minutes before elective surgery, rather than IV paracetamol in the operating theatre.
To ensure patient safety and seamless adoption, anaesthesia staff and pre-anaesthetic clinic nurses were trained on a standardized protocol and additional safety measures were implemented to ensure accurate prescribing, proper administration, and error prevention.
The Impact
Between 2017 and 2022, CGH reduced its carbon emissions by nearly 3,000 kg CO₂e by shifting from IVintravenous to oral paracetamol for elective surgeries. That’s equivalent to eliminating around 3,000 plastic bottles of IV paracetamol each year.
The change was integrated into the care pathway for all adult elective surgical patients, except those with specific medical conditions or allergies, reaching the vast majority of the hospital’s 15,000 surgeries annually.
In addition to its environmental benefits, the switch led to over fourfold cost savings, with paracetamol expenditure dropping from $1,803 to $424 per 1,000 cases – all while maintaining patient safety and care quality.
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For more information
Jo-Anne Yeo, Michelle B.H. Tan, Ee Teng Ong, Adrian Wong, Xuan Han Koh, Avinash Gobindram, Reducing costs and carbon footprint for preoperative oral paracetamol: implementation of a standardised pathway, British Journal of Anaesthesia, 2024
Acknowledgements
The Centre for Sustainable Medicine would like to thank Dr Yeo, Dr Gobindram, Nurse Hanwar, and the whole medical team for leading the implementation, as well as to the Communications team at Changi General Hospital for their invaluable support.