Reducing the CO2e of Orthopaedic Surgery

Project completed as part of the 2024 Hampshire Hospitals NHS Foundation Trust (HHFT) Green Team Competition.

Team members:

• Laura Vale - Senior Operating Department Practitioner
• Krithea Baker - Recovery Nurse Practitioner
• Dr Jaco DeBeurs - Specialist Doctor Anaesthetics
• With special thanks to Oliver Grassby (CT2 Anaesthetics), Jessica Lynch (CT1 Anaesthetics), Alhan Al-Sammak (Speciality Doctor) & Ellie Watson.

Setting / Patient Group: Patients undergoing arthroplasty procedures

Issue:

Arthroplasty procedures present significant opportunities for carbon reduction given their high use of single-use consumables and energy-intensive equipment. A knee arthroplasty has a carbon footprint of 85 kgCO2e.

HHFT performed 991 arthroplasty procedures in 2023-2024, and this number is expected to grow with the establishment of a new elective arthroplasty centre. Given the volume of such surgeries and their reliance on disposable products, targeted improvements could meaningfully reduce emissions.

We identified six changes that could be made to improve sustainability of arthroplasty procedures.

Intervention and outcomes:

1. Switch from Ethyl Chloride Spray to The CoolStick®: This involved replacing a disposable anaesthetic cooling spray with a reusable, non-inferior alternative.

• Environmental: Saved 6,240.91 kgCO2e.
• Social: Feedback collection is ongoing.
• Clinical: Non-inferior in terms of patient anaesthetic experience.
• Financial: Annual savings of £10,621.56.

2. Reusable Positioning Pad for Hip Arthroplasty: Transition from a reusable device with single-use foam inserts to a fully reusable pad.

• Environmental: Reduced emissions by 166.68 kgCO2e.
• Social: Positive reception by staff due to reduced preparation time.
• Clinical: No impact on patient outcomes.
• Financial: Annual savings of £11,106.80

3. Switch from Intravenous to Oral Paracetamol: Encouraged use of oral paracetamol over intravenous

• Environmental: Reduced emissions by 440.43 kgCO2e.
• Social: Majority of staff willing to adopt the change.
• Clinical: In line with NICE guidelines and reduces need for additional hypotension management.
• Financial: Annual savings of £855.80.

4. Reducing Waste in Spinal Anaesthesia Packs: Elimination of unnecessary items from spinal packs to decrease material wastage.

• Environmental: Saved 544.62 kgCO2e.
• Social: Reduced staff frustration; formal feedback pending.
• Clinical: No impact on patient outcomes.
• Financial: Annual savings of £11,180.50.

5. Reduce energy consumption by switching off Heating, Ventilation, and Air Conditioning (HVAC) systems and Anaesthetic Gas Scavenging Systems (AGSS) when theatres are unoccupied (Not yet implemented)

• Environmental: Estimated savings of 58,658 kgCO2e.
• Social: Aimed to improve staff burden with energy-saving automation.
• Clinical: No anticipated impact on patient outcomes.
• Financial: Estimated annual savings of £34,203.

6. Ecopulse Device Implementation: Proposal to replace disposable, battery-powered pulse lavage devices with a lower-carbon alternative. This has not been implemented due to additional costs (therefore potential impacts have been excluded from total savings).

• Environmental: Expected reduction of 2,789.64 kgCO2e.
• Social: Anticipated noise reduction benefits for theatre staff.
• Clinical: No impact on patient outcomes.
• Financial: Annual cost increase of £7,601.04.

The first 5 projects combined have potential annual savings of £67,968 and 66,051 kgCO2e, equivalent to driving 195,071 miles.

Key Learning Point:

The initiative demonstrated that even small, targeted changes could lead to substantial carbon reductions and cost savings when embedded across a department. To enable change to happen in a complex environment like the operating theatres involves many stakeholders. It is important that these stakeholders are engaged early in the project as some of the processes of engagement can be lengthy. A good relationship with stakeholders was a key element that contributed to the success of our project.

Going forward, we aim to ensure that these initiatives become embedded into daily practice, through review and audit of our processes. The aspects of our project that are yet to be implemented will be prioritised, and data collection ongoing to measure the impacts across the triple bottom line and improve sustainable value in our department.

This project highlighted to us that even when problems or barriers occurred during the implementation stage or the results were not as expected there was still key learning and knowledge to gain. Not all projects will achieve the triple bottom line but the QI practice that is involved in the process of completing a project provides good learning and experience.

To ensure lasting change, we plan to continue to engage with our department, providing updates on projects at clinical governance and also present our findings at relevant events across the trust. We will also continue to seek opportunities to align with national recommendations as outlined in the green surgery report (2023) and work towards a net zero NHS.