Carbon footprinting for hospital care pathways based on routine diagnosis‐related group (DRG) accounting data in Germany: An application to acute decompensated heart failure

A general framework is developed using routine German diagnosis‐related group (G‐DRG) accounting data to estimate carbon footprints of hospital care pathways in the context of patients with acute decompensated heart failure (ADHF) admitted to the Red Cross Hospital Bremen in 2018. Financial activity data encompass G‐DRG material costs from hospital accounting data submitted to the Institute for the Hospital Remuneration System. A set of seven greenhouse gases (GHGs) is included. Environmentally extended input–output emission factors (EFs) compiled by Eurostat are employed. EFs of cost modules are calculated separately considering respective emissions' intensities. Total emissions reach 72,652 kg carbon dioxide equivalent (CO2e) (nonbiogenic: 85.5%; biogenic: 14.5%) for general inpatient care throughout ADHF patient care pathways in 2018. Emissions from normal wards account for the largest proportion (74.8%) of total emissions for ADHF patients. Compared to other matched industry categories, cost‐types covered by the industry category D “electricity, steam and air conditioning supply” cause the vast majority (approximately 87%) of total emissions. GHG emissions per unit of analysis, per bed day, and per euro are estimated at 263, 32, and 0.31 kg CO2e, respectively. Although this framework is currently limited to hospitals that participate in the G‐DRG calculation scheme or apply these accounting standards on a voluntary basis, it has particular advantages that render it amenable to other contexts. It enables the calculation of emissions separately for each cost module considering its specific emission intensity, which can improve the accuracy of estimates.