Environmental sustainability studies in US hospitals from 2015-2025: A scoping review of geographic and clinical trends

Kelli Pajarit Fletcher , Thomas W Gillespie

The healthcare sector is responsible for an estimated 8% of the United States’(US) total greenhouse gas emissions, and the US is one of the largest global carbon emitters, responsible for an estimated quarter of all global healthcare emissions. The primary objectives of this scoping review are to understand geographic, medical specialty, pre/post-pandemic publishing trends, and major research areas of environmental sustainability in US hospitals from the past ten years. Of the articles screened, 41 met inclusion criteria. The Northeast region accounted for the largest share of studies with 39.5% followed by the Midwest region (21%) and West region (21%) while the Southern region showed the least number of studies (18.6%). The pre-pandemic period of 2015-19 accounts for 29% of studies, while the post-pandemic period (2020-25) holds the majority share with 71%. Surgery and Anesthesia were the primary medical specialties involved, together accounting for more than half of all studies. The predominant research focus was healthcare emissions, which accounted for 64% of all studies followed by implementation, benchmarking, and accounting (31%) and the least was education (5%). Hospital-level performance metrics and reporting guidelines are still needed to increase transparency and improve environmental stewardship that can also be easily integrated into business operations. Although there has been progress in the past decade regarding environmental sustainability in US hospitals, the lack of regulatory governance structures continues to foster an extremely fragmented geographic research landscape.