Don’t recommend/order investigations or interventions before discussing patients’ expected trajectory of health and life expectancy, and exploring their preferences, values and goals of care.

Interventions that do not align with patient goals produce needless environmental impacts. Ensuring that care setting aligns with a patient’s goals of care can have an important impact on the carbon footprint of a hospital admission. An acute care unit (ward bed) generates 5.5kg of solid waste and 45kg CO2e (218 km by car) per hospital day, as compared to 7.1kg of solid waste and 138 kg CO2e (670 km by car) in an intensive care unit. By integrating routine cognitive and frailty screening for older patients (a low carbon, high value clinical intervention), internists can unmask dementia and discuss the risks of frailty with patients and caregivers which leads to more patients choosing conservative care better aligned with their prognosis and goals, and stands to reduce acute care days.