Objective: The purpose of this project is to enhance the green healthcare and sustainable medicine practices in the Hospital of the University of Pennsylvania Department of Emergency Medicine. Methods: The Green Team, consisting of staff members from various departments throughout the hospital, met on a weekly basis to discuss and implement new green changes and initiatives. The Green Healthcare Audit forms, obtained from the Teleosis Institute, were utilized to evaluate the hospital current performance and the information gained has guided and will continue to guide the Green Team in their efforts to make effective changes. Categories of the Green Healthcare audit include: (1) Solid Waste Reduction Recycling, (2) Energy Conservation, (3) Water Conservation, (4) Pollution Prevention, (5) Medical Technology, (6) Healthy People. Results: The Green Healthcare audit identified numerous areas that need improvement in order to be on the path towards an environmentally sustainable healthcare facility. These improvements include: (1) Hospital wide recycling program, (2) Paper waste minimization, (3) Red-bag waste minimization, (4) Green purchasing (replacing styrofoam cups and single use medical devices), (5) Electricity management (energy efficient, motion sensor lights), (6) Pharmaceutical waste management. On Earth Day, April 22, 2009, HUP started a commingled recycling program in the cafeteria, Department of Emergency Medicine, and Department of Surgery. The Department of Emergency Medicine also initiated a program to minimize paper waste bye mailing messages to individuals who waste paper at the printer. A red-bag waste minimization project has also been initiated, in which the current red-bag waste performance is audited and educational materials are provided to initiate improvements throughout the hospital where they are needed. Discussion: A total score of 31% on the Green Healthcare Audit is probably on par or better than numerous hospitals throughout the U.S., but demonstrates the need for improvement to constitute having ecological sustainable healthcare as a priority. Currently there is a significant lack of standardized knowledge throughout healthcare settings about the numerous facets of ecologically sustainable healthcare. Creating a positive impact on an institution greenness can be a realistic short-term goal by using proper environmental assessments and interventions. Individuals are ready and eager for structured change and the implementation of innovative environmentally sustainable practices. Creating comprehensive change in a major institution requires top-down, bottom-up, and from-the-middle approaches; yet, everything begins with individuals. Conclusion: HUP Department of Emergency Medicine has initiated procedures to function more sustainably, both economically and environmentally. These new procedures have the potential to enhance quality and efficiency of healthcare, while creating a healthier indoor and outdoor environment. However, monitoring and data collection are needed to assess progress and to suggest future improvements. Through these enhancements, HUP has an opportunity to become a leader in Ecological Sustainable Healthcare. This project utilized a healthcare audit system that was originally adapted from a green office building template. Although the results did yield ample ideas for improvement, future work is needed to create a green healthcare audit that is properly adapted to a major teaching and research-oriented hospital.