Greening the Fluoroscopy Pathway

Case study submitted as part of Lancet Commission call for case studies.

Team members / location: Samantha Holmes, Oxford, UK

Issue: 

Fluoroscopy is an energy-intensive imaging modality, although limited carbon footprinting data exists. Annual audit of a videofluoroscopy clinic identified over 10% of procedures being carried out inappropriately or unnecessarily, due to a lack of understanding of the rationale for undertaking the procedures and an insufficient triaging protocol, resulting in unnecessary waste, radiation exposure to staff and patients, and unnecessary travel to/from hospital sites. 

Intervention: 

The existing referral pathway into the clinic was modified by introducing a clearer triage process, which allowed identification and prevention of inappropriate referrals. This was successful to reduce wastage of resources and prevent unnecessary radiation exposure of staff and patients, although the impact of the intervention on the carbon footprint of the videofluoroscopy clinic could not be calculated accurately.  

Outcomes: 

Clinical

o    Improving patient safety by reduce unnecessary exposure to radiation, whilst reducing wait times for other patients by freeing up capacity.

Environmental

o    Carbon footprinting has not yet been completed for a single fluoroscopy procedure so the environmental impact cannot be directly assessed.

Social

o    Rationalising what is a carbon-intensive procedure to only those patients with a clinical need allows us to benefit those who most need it. Appropriate management of swallowing difficulties can have a huge social impact, due to the social nature of eating and drinking.

Financial

o    10% of patients in the first audit cycle were identified as having been inappropriately referred. If these had been prevented, it would have resulted in a projected £4500-£6000 annual savings. 61 (19%) of referrals were rejected in the second audit cycle, following implementation of the triaging process, which resulted in £18,300-£24,400 of annual savings. 33 (14%) of referrals were rejected in the third audit cycle, which resulted in £9,900-£13,200 of annual savings.

Key learning point: 

The project was successful to bring the existing videofluoroscopy clinic into alignment with national best practice.; identifying the issue of inappropriate referrals; and in preventing inappropriate referrals from being made. Further opportunities for decarbonizing the videofluoroscopy pathway were identified.