Contents lists available at ScienceDirect Resources, Conservation & Recycling journal homepage: www.elsevier.com/locate/resconrec Full length article Quantifying hospital services by carbon footprint: A systematic literature review of patient care alternatives Fadhel Alshqaqeeq a , M. Amin Esmaeili b , Michael Overcash c , Janet Twomey a, * a Wichita State University, Industrial and Manufacturing Engineering Department, College of Engineering, 1845 Fairmount Street, Wichita, KS, USA b Department of Systems and Industrial Engineering, Kennesaw State University, 1100 South Marietta Parkway, Marietta, GA, 30060, USA c Sustainable Materials and Energy Systems, Industrial and Manufacturing Engineering Department, College of Engineering, Wichita State University, 1845 Fairmount Street, Wichita, KS, USA ARTICLE INFO Keywords: Healthcare sector carbon footprint Life cycle assessment Environmentally sustainable practices Hospital energy consumption ABSTRACT Importance: Reducing the carbon footprint of the healthcare sector can be achieved along with quality patient outcomes at lower environmental impact. Objective: For the first time to categorize peer-reviewed articles that report quantitative improvement in greenhouse gas emissions related to medical devices and services, overview of trends, and identify some gaps for future research. Data sources: Database searches resulted in 822 peer-reviewed articles (January 1, 2000 and December 31, 2016) on healthcare and environmental sustainability. Study selection: A systematic review methodology identifies, critically evaluates, and integrates the findings. Articles reviewed 1) provided quantitative global warming potential (GWP) information, 2) were published in peer-reviewed journals, and 3) were related to one of the twelve hospital service categories. Results: Patient care teams are substantially limited by a lack of data related to the environmental impact of their services. Of the one of three potential environmental scopes—travel-related energy, direct energy, and the procured goods and equipment embodied energy—only six articles covered all three scopes. Conclusions and relevance: This research provides healthcare nurses, physicians, and administrators with the location of procedures, patient-based decisions, and other avenues to hospital sustainability improvements in twelve hospital service categories. 1. Introduction Healthcare as a sector is a significant contributor to global warming potential, with about 11 % of the U.S. emissions of carbon dioxide (CO 2 eq) 2011 (Commins, 2018). This large contribution, in addition to the overall concerns about global warming, leads to Public views sup- port the healthcare industry reducing their global warming emissions, while maintaining patientcare quality. Hospitals consume energy (ty- pically electricity and natural gas), utilize materials (reusables and disposables), and most importantly deliver medical services based on patient conditions. Hospitals provide many and complex services and hence involve important medical decisions. Reducing the carbon foot- print of the healthcare sector can be achieved by incorporating en- vironmental considerations into the patient-centered decision-making process of hospitals in order to achieve more environmentally friendly alternative decisions with equivalent patient outcomes. This is a framework developed in 2012 (Overcash and Twomey, 2012a), but currently unexplored compared to building heating, ventilating and air conditioning (HVAC). We expanded this framework for environmental improvement in a recent book and repeated this framework again herein (Twomey and Overcash, 2020). Since each patient-care decision has a resulting environmental impact through energy and material use, the first priority is to conduct the necessary research to create pre- liminary profiles of medical processes and the associated energy and materials use. The objective of this paper was the first comprehensive identifica- tion of what carbon footprint (Global Warming Potential, GWP), as a widely used environmental metric) improvements had been studied, quantifying the GWP benefits and placing these in the twelve hospital service or department categories. This then defines where more re- search has been done and where little research has been done to find medical-based environmental improvements. We also sought any https://doi.org/10.1016/j.resconrec.2019.104560 Received 6 February 2019; Received in revised form 25 October 2019; Accepted 26 October 2019 ⁎ Corresponding author. E-mail addresses: shfadhel@gmail.com (F. Alshqaqeeq), aesmaei3@kennesaw.edu (M. Amin Esmaeili), mrovercash@earthlink.net (M. Overcash), janet.twomey@wichita.edu (J. Twomey). Resources, Conservation & Recycling 154 (2020) 104560 0921-3449/ © 2019 Elsevier B.V. All rights reserved. T