PROJECT SUMMARY Motivation: The healthcare sector generates 8.5% of all greenhouse gas (GHG) emissions in the United States. Ironically, by providing care to our patients, we contribute to the climate crisis and thereby to the detriment of human health. We need to quickly transition to a sustainable care model that provides high quality and safe care now and for future generations. With 18 million endoscopic procedures performed annually in the United States, gastrointestinal endoscopy is a likely major contributor to the healthcare's environmental impact, however, its carbon footprint is unknown. Aims and hypothesis: The proposed pilot project aims to measure the carbon footprint of performing an endoscopic procedure and to implement and assess immediately actionable interventions to lower the carbon footprint. We hypothesize that we will be able to obtain representative estimates on the carbon footprint and to identify and implement easily actionable practice changes and associated emissions savings. Method: We will use life cycle assessment (LCA) methodology to calculate the carbon footprint of endoscopic procedures with and without interventions at four representative medical facilities. The LCA will include all aspects related to the procedure from manufacturing and distribution of instruments and supplies, performance of an endoscopy, reprocessing of reusable instruments, and disposal of waste (so call “cradle-to-grave” analysis). We will identify process steps, inputs, and other components that will likely influence carbon emissions and rank them in order of ease of implementation. We will then implement easily actionable low- carbon approaches, and re-estimate the carbon footprint. The main outcome is the carbon footprint for individual procedures. We will present other outcomes of environmental impact, including energy demand, acidification, eutrophication, and generation of toxic waste. In addition, we will perform a sensitivity analysis using minimum and maximum values obtained at different endoscopy units. Finally, we will calculate emissions savings as a result of immediately actionable practice changes. Impact: The study will establish a baseline unit of environmental impact of performing endoscopic procedures – the carbon cost of an endoscopic procedure. The results will provide the foundation for future studies on carbon footprint of our practice and health outcomes. Notably, the pilot project will also test a dynamic approach of implementing immediate actionable process alternatives and thereby provide an understanding of what emission savings are possible from immediate actions. The study will provide an initial understanding of challenges related to implementing practice changes that will inform future studies focused on implementation. Timeline and feasibility: Considering the urgency of the topic we propose a one-year timeline. Given our prior established working experience and our initial preliminary work on this concept, we...