Cassandra Lee Thiel- PhD
- Professor (Assistant) at New York University
Cassandra Lee Thiel
- PhD
- Professor (Assistant) at New York University
About
92
Publications
29,996
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Introduction
My research aims to increase the resource efficiency of healthcare delivery while maintaining quality outcomes. I use sustainable engineering tools, such as life cycle assessment (LCA) and the principles of industrial ecology, to systematically measure and analyze the environmental performance of medical services and systems. The healthcare sector emits 10% of the US’s greenhouse gases and 9% of criteria air pollutants, leading to adverse health effects. My research seeks to reduce hospital resource use, increase efficiency of healthcare delivery, and minimize emissions in medical product supply chains and waste streams. We do this by analyzing individual procedures, identifying opportunities for improvement, developing relevant technologies, and testing interventions.
Current institution
Additional affiliations
November 2014 - March 2015
August 2009 - August 2013
Education
August 2009 - August 2013
August 2004 - April 2009
Publications
Publications (92)
The healthcare sector is a driver of economic growth in the US, with spending on healthcare in 2012 reaching $2.8 trillion or 17% of the US gross domestic product, but it is also a significant source of emissions that adversely impact environmental and public health. The current state of the healthcare industry offers significant opportunity for en...
Purpose:
To measure the waste generation and lifecycle environmental emissions from cataract surgery via phacoemulsification in a recognized resource-efficient setting.
Setting:
Two tertiary care centers of the Aravind Eye Care System in southern India.
Design:
Observational case series.
Methods:
Manual waste audits, purchasing data, and int...
Healthcare is a critical service sector with a sizable environmental footprint from both direct activities and the indirect emissions of related products and infrastructure. As in all other sectors, the “inside‐out” environmental impacts of healthcare (e.g., from greenhouse gas emissions, smog‐forming emissions, and acidifying emissions) are harmfu...
Pollution is a leading cause of morbidity and mortality, and was associated with an estimated 9 million premature deaths globally in 2015 or 16% of all deaths.¹ Most environmentally mediated deaths are linked to air pollution,¹ with many health experts believing climate change is the leading public health issue of the 21st century. Major disruption...
Importance
Pharmaceutical products, including unused portions, may contribute to financial and environmental costs in the United States. Because cataract surgery is performed millions of times each year in the United States and throughout the rest of the world, understanding these financial and environmental costs associated with cataract surgery i...
This study reviews life cycle assessments (LCAs) of reprocessed single-use devices (rSUDs) in healthcare to quantify their greenhouse gas (GHG) emission reductions compared to original equipment manufacturer (OEM) SUDs (single-use devices). rSUDs offer notable reductions in solid waste generation, but, until recently, a reduction in greenhouse gase...
BACKGROUND: Healthcare is a major contributor to global greenhouse gas emissions. Colorectal cancer (CRC) screening is one of the most widely used healthcare services in the US, indicated for approximately 134 million adults. Recommended screening options include fecal immunochemical tests (FITs) every year, CT colonographies (CTCs) every 5 years,...
(1) Background: Healthcare is a major contributor to global greenhouse gas (GHG) emissions, especially within the surgical suite. Ophthalmologists play a role, since they frequently perform high-volume procedures, such as cataract surgery. This review aims to summarize the current literature on surgical waste and GHG emissions in ophthalmology and...
Introduction
There is increasing prevalence of single‐use flexible laryngoscopes in Otolaryngology. This study aims to quantify and compare the environmental outcomes of single‐use disposable flexible laryngoscopes (SUD‐Ls) and reusable flexible laryngoscope (R‐Ls).
Methods
The ISO 14040 standardized Life Cycle Assessment (LCAs) was utilized to es...
A life cycle assessment of a diagnostic radiology department’s environmental footprint identified the energy consumption from imaging equipment as more than 50% of its greenhouse gas emissions, as well as opportunities to improve its sustainability.
Increased concern over climate change and the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus resulted in a clash of political directives around reusable and disposable food serviceware. Decreasing single-use items will likely reduce consumption and environmental emissions; however, improper cleaning of reusable...
This Viewpoint proposes a comprehensive sociotechnical approach spanning the entire plastics life cycle to reduce plastic use and pollution in health care.
Purpose
To analyze waste from intraocular lens (IOL) packaging across a variety of brands.
Setting
Private clinical practice
Design
Prospective weight and composition analysis of all elements of unopened packages of IOLs sold in the US—both preloaded and non-preloaded.
Methods
Samples were collected from multiple IOL companies in 2023. The prima...
Background
Health care providers worldwide are rapidly adopting electronic medical record (EMR) systems, replacing paper record-keeping systems. Despite numerous benefits to EMRs, the environmental emissions associated with medical record-keeping are unknown. Given the need for urgent climate action, understanding the carbon footprint of EMRs will...
Concern over climate change is growing in the healthcare space, and telemedicine has been rapidly expanding since the start of the COVID19 pandemic. Understanding the various sources of environmental emissions from clinic visits-both virtual and in-person-will help create a more sustainable healthcare system. This study uses a Life Cycle Assessment...
Purpose:
Concurrent increases in global cancer burden and the climate crisis pose an unprecedented threat to public health and human wellbeing. Today the healthcare sector greatly contributes to greenhouse gas emissions, with the future demand for healthcare services expected to rise. Life cycle assessment (LCA) is an internationally standardized...
Topic:
Understanding approaches to sustainability in cataract surgery and their risks and benefits CLINICAL RELEVANCE: In the United States, healthcare is responsible for approximately 8.5% of greenhouse gas (GHG), and cataract surgery is one of the most commonly performed surgical procedures. Ophthalmologists can contribute to reducing GHG emissi...
During the start of the COVID-19 pandemic, shortages of personal protective equipment (PPE) necessitated unprecedented and non-validated approaches to conserve PPE at healthcare facilities, especially in high income countries where single-use disposable PPE was ubiquitous. Our team conducted a systematic literature review to evaluate historic appro...
Background:
Reducing low-value clinical care is an important strategy to mitigate environmental pollution caused by health care.
Objective:
To estimate the environmental impacts associated with prostate magnetic resonance imaging (MRI) and prostate biopsy.
Design, setting, and participants:
We performed a cradle-to-grave life cycle assessment...
Waste generated by health care includes harmful emissions and often disproportionately affects already vulnerable communities. Justly restructuring health care waste management involves better understanding key drivers of waste production, using sustainability as an ethical value to guide disposal decisions and practices, and reducing overall dispo...
Covid-19 has led to an increase in the use of PPE, gowns, masks, sanitizers, air circulators, and much more, all contributing to an increase in medical waste (1). Waste generation is one issue. Emissions are another. The two are linked because waste and emissions are both indicators of consumption. However, waste is not the biggest driver of enviro...
BACKGROUND
Health care providers worldwide are rapidly adopting electronic medical record (EMR) systems, replacing paper record-keeping systems. Despite numerous benefits to EMRs, the environmental emissions associated with medical record-keeping are unknown. Given the need for urgent climate action, understanding the carbon footprint of EMRs will...
The United States health care industry is the second largest in the world, expending an estimated 479 million metric tons (MMT) of carbon dioxide per year, nearly 8 percent of the country's total emissions. The importance of carbon reduction in health care is slowly being accepted. However, efforts to “green” health care are incomplete since they g...
Healthcare generates large amounts of waste, harming both environmental and human health. Waste audits are the standard method for measuring and characterizing waste. This is a systematic review of healthcare waste audits, describing their methods and informing more standardized auditing and reporting. Using Preferred Reporting Items for Systematic...
The demand for eye care—the most common medical speciality in some countries—is increasing globally due to both demographic change and the development of eye health-care services in low-income and middle-income countries. This expansion of service provision needs to be environmentally sustainable. We conducted a scoping review to establish the natu...
Background
The US health care system is the second largest contributor of trash. Approximately 20% to 70% of waste is produced by operating rooms, and very few of this waste is recycled. The purpose of this study is to quantify the opened but unused disposable supplies and generate strategies to reduce disposable waste.
Methods
A single-center pro...
Objectives
High-value care is providing high quality care at low cost; we sought to define hospital value and identify the characteristics of hospitals which provide high-value care.
Design
Retrospective observational study.
Setting
Acute care hospitals in the USA.
Participants
All Medicare beneficiaries with claims included in Center for Medica...
There is increasing understanding, globally, that climate change and increased pollution will have a profound and mostly harmful effect on human health. This review brings together international experts to describe both the direct (such as heat waves) and indirect (such as vector‐borne disease incidence) health impacts of climate change. These impa...
Background
We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations.
Methods
Drawing on methods used in previou...
Purpose
Environmental sustainability is a growing concern to healthcare providers, given the health impacts of climate change and air pollution, and the sizable footprint of healthcare delivery itself. Though many studies have focused on environmental footprints of operating rooms, few have quantified emissions from inpatient stays. This study quan...
There is increasing understanding, globally, that climate change and increased pollution will have a profound and mostly harmful effect on human health. This review brings together international experts to describe both the direct (such as heat waves) and indirect (such as vector-borne disease incidence) impacts of climate change depending on their...
The healthcare sector is responsible for 8.5% of greenhouse gas (GHG) emissions in the United States. To prevent catastrophic effects of climate change, urgent reductions in GHG emissions are needed. Unnecessary preoperative testing and clinic visits contribute to excessive utilization of healthcare resources and patient travel, and addressing them...
Objective
Though one of the most common surgeries, there is limited information on variability of practices in cataract surgeries. ‘Eyefficiency’ is a cataract surgical services auditing tool to help global units improve their surgical productivity and reduce their costs, waste generation and carbon footprint. The aim of the present research is to...
Objectives:
Given adverse health effects of climate change and contributions of the US health care sector to greenhouse gas (GHG) emissions, environmentally sustainable delivery of care is needed. We applied life cycle assessment to quantify GHGs associated with processing a gastrointestinal biopsy in order to identify emissions hotspots and guide...
This study measured the total quantity and composition of waste generated in a large, New York City (NYC) hospital kitchen over a one-day period to assess the impact of potential waste diversion strategies in potential weight of waste diverted from landfill and reduction in greenhouse gas (GHG) emissions. During the one-day audit, the hospital kitc...
Purpose
To calculate the volume of greenhouse gases (GHG) generated by a hospital-based interventional radiology department.
Materials and Methods
Life cycle assessment (LCA) was used to calculate GHG emitted by an IR department at a tertiary care academic medical center during a single workweek. The volume of waste generated, the amount of dispos...
Environmental considerations and other resource constraints make it impossible for the current cataract surgical practices of high-income countries to be continued far into the future. The evidence to support the need for change and the opportunities for change are presented. Individual ophthalmologists can adapt their practice to make it more sust...
A circular economy involves maintaining manufactured products in circulation, distributing resource and environmental costs over time and with repeated use. In a linear supply chain, manufactured products are used once and discarded. In high-income nations, health care systems increasingly rely on linear supply chains composed of single-use disposa...
Introduction:
Healthcare contributes 10% of greenhouse gases in the United States and generates two milion tons of waste each year. Reducing healthcare waste can reduce the environmental impact of healthcare and lower hospitals' waste disposal costs. However, no literature to date has examined US emergency department (ED) waste management. The pur...
Cataract surgery is the most commonly performed medical procedure in the world but there continues to be a large, unmet requirement for more surgery, with cataract still accounting for one third of all global blindness. A great deal of progress has been made in increasing cataract surgical rates or productivity, and associated cost containment. How...
Minimising the footprint of cataract surgery: a blueprint for surgical sustainability.
In an online survey of more than 1300 cataract surgeons and nurses, 93% believed that operating room waste is excessive and should be reduced; 78% believed that we should reuse more supplies; 90% were concerned about global warming; and 87% wanted medical societies to advocate for reducing the surgical carbon footprint. The most commonly cited reas...
Waste auditing is important for effectively reducing the medical waste generated by resource-intensive operating rooms. To replace the current time-intensive and dangerous manual waste auditing method, we propose a system named iWASTE to detect and classify medical waste based on videos recorded by a camera-equipped waste container. In this pilot s...
To the Editor In their article, “Association of Disposable Perioperative Jackets with Surgical Site Infections in a Large Multicenter Health Care Organization,”¹ Stapleton et al performed a retrospective analysis and found no significant difference in the incidence of surgical site infection (SSI) after clean procedures, 26 months before and 26 mon...
In Reply Mr Cahan and colleagues comment on our Viewpoint¹ on the importance of supply optimization in improving the value of health care delivery. We agree with the authors that reducing variability in surgical utilization can be accomplished through consolidating device vendors and integrating purchasing decisions in a way that does not inappropr...
The United States spends nearly twice as much on health care as other high-income countries, yet it achieves some important outcomes that are worse. Historically, high health care spending in the United States was considered to be attributable to disproportionately high utilization. Recent cross-national comparisons, however, show that health care...
Purpose
We measured waste from glaucoma surgeries at an eye care facility in Southern India and compared these results to a community hospital in the United States.
Methods
The waste produced in the glaucoma operating room at Aravind Eye Hospital, Madurai, India from June 22 to July 15, 2015 was weighed and compared to the waste produced in the gl...
Objectives:
To determine the carbon footprint of various sustainability interventions used for laparoscopic hysterectomy.
Methods:
We designed interventions for laparoscopic hysterectomy from approaches that sustainable health care organizations advocate. We used a hybrid environmental life cycle assessment framework to estimate greenhouse gas e...
Infrastructure plays a key role in 21st century sustainability challenges related to burgeoning populations, increasing material and energy demand, environmental change, and shifts in social values. Social and political controversy over infrastructure decision making will continue to intensify without robust interdisciplinary and intersectoral dial...
Background:
The US health care sector has substantial financial and environmental footprints. As literature continues to study the differences between wide-awake hand surgery (WAHS) and the more traditional hand surgery with sedation & local anesthesia, we sought to explore the opportunities to enhance the sustainability of WAHS through analysis o...
Background
While petroleum-based plastics are extensively used in health care, recent developments in biopolymer manufacturing have created new opportunities for increased integration of biopolymers into medical products, devices and services. This study compared the environmental impacts of single-use disposable devices with increased biopolymer c...
Objectives:
Global warming (or climate change) is a major public health issue, and health services are one of the largest contributors to greenhouse gas emissions in high-income countries. Despite the scale of the health care sector's resource consumption, little is known about the attitude of physicians and their willingness to participate in eff...
Aging water infrastructure and increased water scarcity have resulted in higher interest in water reuse and decentralization. Rating systems for high-performance buildings implicitly promote the use of building-scale, decentralized water supply and treatment technologies. It is important to recognize the potential benefits and tradeoffs of decentra...
Evidence-based design (EBD) studies have grown rapidly over the last decade, attempting to link traditional building design to building occupants, with a particular emphasis on healthcare settings. Additionally, there has been an increase in green building design (GBD) for most new construction; however, the effects of GBD on the use phase and occu...
The development of green building rating systems (GBRS) and sustainability metrics for buildings, including building products, is reviewed from a North American perspective. The Leadership in Energy and Environmental Design (LEED) system and the Living Building Challenge (LBC) are highlighted as primary examples of different levels of GBRS. Life cy...
Purpose of review:
This article raises awareness about the cost-effectiveness and carbon footprint of various cataract surgery techniques, comparing their relative carbon emissions and expenses: manual small-incision cataract surgery (MSICS), phacoemulsification, and femtosecond laser-assisted cataract surgery.
Recent findings:
As the most commo...
This dissertation quantifies and analyzes the environmental and human health impacts associated with healthcare through assessment of the physical built environment of a hospital as well as the processes and procedures conducted within the building. Healthcare, especially in the United States, seeks to reduce cost and improve human health in part b...
![System boundary: material phase for illustrative case study [33].](publication/237011469/figure/fig1/AS:11431281397221844@1745497485738/System-boundary-material-phase-for-illustrative-case-study-33_Q320.jpg)
This study analyzed the environmental impacts of the materials phase of a net-zero energy building. The Center for Sustainable Landscapes (CSL) is a three-story, 24,350 square foot educational, research, and administrative office in Pittsburgh, PA, USA. This net-zero energy building is designed to meet Living Building Challenge criteria. The larges...
Despite being a heavily regulated industry and one in which patient safety and wellbeing trumps many other concerns, healthcare's environmental impacts can be improved. Using Life Cycle Assessment (LCA) to quantify the environmental impacts associated with cesarean section and vaginal births at a US hospital, this study identifies aspects of birthi...
This study introduces life cycle assessment as a tool to analyze one aspect of sustainability in healthcare: the birth of a baby. The process life cycle assessment case study presented evaluates two common procedures in a hospital, a cesarean section and a vaginal birth. This case study was conducted at Magee-Womens Hospital of the University of Pi...
A fundamental principle of business states that the primary purpose of a corporation is to generate a profit for its stakeholders. Historical belief posited that this profit must come at the expense of the environment and that environmental health and corporate profitability are mutually exclusive principles. More recently however, the ideas of cor...
ONE of the principle rules of medical ethics is the oath, “First, do no harm.” Nearly everyone in the developed world is impacted by healthcare. In 2008, US hospitals employed over 5.3 million people and spent nearly $320 billion on goods and services from other businesses [1]. In 2009, healthcare represented about 17% of the total US GDP. The heal...
Questions
Questions (3)
Hi, we are trying to determine what hospitals are doing to conserve PPE (personal protective equipment) during the Covid-19 pandemic. If you happen to work at a medical school or hospital and are aware of their policies or practice (or have friends who do), please consider filling this out. We are generically looking for US hospitals, but other locations are welcome.
Thank you!
I am specifically looking for impacts of "landfilling" or dumping practices in southern India, but it's similar to waste management in many developing countries.
I am setting up an LCA of a medical waste system in India, and was wondering what LCI databases and LCIA methods are used. In the past, I have typically used USLCI or Ecoinvent and TRACI, but those were all LCAs set in the US.
