Objectives. The objective of this Technical Brief is to assess the current use of life cycle assessment (LCA) frameworks in healthcare research and practice, understand the components of those frameworks, review LCA studies that have been conducted, and assess gaps in research and practice to guide future directions.

Review methods. A scoping review combined with Key Informant interviews provided the input for the report. We searched a combination of biomedical (PubMed®); environmental (Agricultural & Environmental Science Collection, Environmental Science Database, Environment Index); and technical research (Web of Science, Scopus) databases for this interdisciplinary research topic. Gray literature sources included the research registries ClinicalTrials.gov, National Institutes of Health (NIH) RePORTER, Environmental Protection Agency Health and Environmental Research Online (HERO), European Research Council projects, and the International Clinical Trials Registry Platform (ICTRP) for ongoing research. Citation screening involved two independent reviewers who screened full text, supported by machine learning. Data were abstracted in a pilot-tested database. Key Informants included experts in LCA frameworks, healthcare operations, developers of tools for healthcare organizations/providers, researchers, organizational policy, and industry.

Findings. Searches identified 5,430 citations, of which 836 were obtained as full text; 178 publications met eligibility criteria. We identified nine LCA frameworks, the majority of which were adapted rather than developed for healthcare, using existing frameworks for LCA on residential construction, financial reporting, health technology assessment, and handprint analysis. The frameworks were published in the last 5 years and were not found to be applied in any other study. In total, we identified 164 LCAs published in the scientific literature, primarily originating in the United States, United Kingdom, and Australia. Additional literature originated from Canada and Asian, European, and Latin American countries. Approximately a third of the studies were published by U.S.-based researchers. The studies explored a wide range of topics, from medical devices, products, and surgeries, to emissions from healthcare systems. The majority of studies addressed the full life cycle, from cradle to grave. Key Informants emphasized the importance of LCA to support reduction of healthcare emissions and waste, but noted time and resource limitations for conducting LCAs in clinical practice. The registered studies on frameworks and future research is sparse; we identified eight relevant projects.

Conclusion. LCA frameworks were mainly adapted for healthcare and there is a need to develop a healthcare-specific LCA framework. Future research may need to focus on less resource intensive LCA methods to address the multitude of timely decisions that need to be made in routine healthcare operations. Future work should focus on developing scalable solutions that can be rapidly adopted and implemented in disparate healthcare settings. To address gaps, research should include development of a healthcare-specific life cycle inventory database, a healthcare-specific LCA methodology, and study reporting guidelines to ensure robustness of the LCA studies. It is critical for healthcare to understand the sector's role in climate change, to assess the impacts from healthcare delivery, and to address healthcare industry waste and greenhouse gas emissions.