Sustainably supporting mobility - Developing a walking aid re-use scheme at GOSH

Project completed as part of the Great Ormond Street Hospital Green Team Competition.

Team members: Nicola Moore, Zoe Vamplew, Amy Young and Rachel Naunto, Physiotherapists

Setting / patent group: physiotherapy department in paediatric hospital

Issue:

Walking aids have historically been single use items and not accepted back by NHS Trusts. However, this has changed due to initiatives such as Greener NHS, who published a detailed how-to guide  “10 reasons why to start or expand a walking aid reuse and return scheme” to support Trusts to establish in-house walking aid re-use and refurbishment schemes. Greener NHS have also developed a coordinated return scheme for patients in collaboration with Sustainable Healthcare Network Hub. Within this, patients can return used walking aids to local drop off points at a variety of locations

As a physiotherapy team, we had identified that walking aid reuse was an area our hospital could improve on significantly and started the return scheme in January 2022. However, while we have been receiving reused aids under the scheme for some time, we identified that we could significantly improve both the return of aids by patients and the amount of aids being re-used.

Intervention:

Following research and a staff survey of current practice and understanding of returns processes, we created a standardised pathway for physiotherapy staff to safely assess, clean and refurbish returned aids for re-use. A potential challenge of the time and resources required to undertake the pathway regularly was identified. As a result, we provided education and distributed roles to therapy assistants and administrative staff so that each step of the process had a named person responsible. For example we designated responsibility for the collection of returned walking aids, transporting them to storage and sorting to a specific member of the team.

We identified that we needed to provide consistent advice to families about the new system, and that this needed to be accessible for all. To overcome these barriers the advice included information about how to return aids closer to home and education on how we make the aids safe for reuse. We added the same information to the GOSH website to facilitate wider access. In the short term, advice is provided verbally to families at discharge and clinic appointments and via posters in clinical waiting areas.

Outcomes:

Based on the current return rate (24%), £955 and 1,600 kgCO2e will be saved per year, equivalent to driving 4,725 miles in an average car. The team aim to further improve on the process, which will increase returns and savings. There will be no impact to patient care and clinical outcomes. Socially, staff wanted to see more walking aids returned and re used, however they were unsure of how to do this - the project has helped clarify processes with staff commenting “It is easy to follow” and “following the chart helps me check the aids logically”. Patients have commented “Returning my crutches locally saves a lot of time and hassle” and “I’m happy they’re not just going to waste”

Key learning point

Overall, this project has been useful to help understand the processes required to undertake a detailed quality improvement on our existing walking aid re-use scheme.  The key elements that contributed to this learning was the wider discussion with professionals around carbon footprinting and how to set up a quality improvement project. Also the wider research and national webinars were interesting to attend and discuss to learn what is going on in the wider NHS.