SusQI case study: Back to the Future: Bringing back “old practices” for a sustainable future.

Rachel McLean's picture


Resource Description: 

SusQI project completed at Imperial College Healthcare NHS Trust, as part of the Green Surgery Challenge, 26/04/2021 – 07/07/2021. The case study attached has been updated to reflect progress as of April 2022. 



  • Aim 1: To convert as many Inguinal hernia repair (IHR) from general anesthesia (GA) to local anesthesia (LA) as clinically appropriate and in line with the wishes of the patient.
  • Aim 2: To replace single-use disposable surgical gowns with reusable surgical gowns in the Imperial Surgical Innovation Centre.

Method and measurement:

We engaged teams to understand current practice and suggest suitable alternatives relevant to our aims. We completed audits of current practice and literature reviews. We implemented educational campaigns via meetings and posters. Resource use was compared from patient induction of anaesthesia to discharge for both GA vs LA pathways, with resources measured to calculate financial and environmental savings.


Inguinal hernia project: Our literature review, audit and study suggest IHR under LA appears to be quicker, safer, and likely to improve surgical flow. We found lower risk of complications and reduced length of stay by 53.2% (4 hours, 9 minutes) with LA vs GA, with no obvious post surgical differences between patients. For the 10 cases in the study period, 102 KgCO2e and at least £699.97 was saved. As the literature suggests up to 64% of cases via LA is achievable, 138 cases yearly could be switched to LA in our trust, which could save 2005.14 KgCO2e and £15,984.54/year.

Reusable gown project: Moving to reusable gowns saved £118.52 and 1025.05 kgCO2e across our 8 week trial. If reusable gowns were introduced across our trust, we estimate a saving of 234,660.92 kgCO2e and £27,131.69/year. 91% staff reported positively following clinical use of the gowns.


Our interventions demonstrated significant clinical, social, environmental and financial savings and align with the values highlighted in the trust’s new ‘Green Plan’. This project served as a catalyst in education and has supported further pilot sustainability programmes within other departments in the trust


  • Jasmine Winter Beatty: Surgical Registrar, Imperial College Healthcare NHS Trust (ICHNT); Clinical Research Fellow, Imperial College London (ICL).
  • Jonathan Gan: Surgical Registrar, ICHNT; Clinical Research Fellow, Imperial College London.
  • Henry Robb: Surgical Core Trainee, ICHNT
  • Simon Dryden: Clinical Research Fellow, Institute of Global Health Innovation, ICL.
  • Patricia Ortega: Bariatric Surgery Fellow, ICHNT
  • Tabetha Granger: Surgical Core Trainee, ICHNT
  • Ben Russell: Foundation Year 1 doctor, ICHNT
  • Sanjay Purkayastha: Consultant Bariatric Surgeon, ICHNT; Senior Clinical lecturer, ICL.
  • Mike Kynoch: Anaesthetic Consultant, ICHNT

You can read more about the project by downloading the attached case study or at this link: Introducing team 5 of the Green Surgery Challenge | Centre for Sustainable Healthcare

You can read more about the Green Surgery Challenge and watch the recording here: Green Surgery Challenge | Centre for Sustainable Healthcare

Resource File: 

Publication date: 

August, 2022

Resource type: 

  • case study

Register or log in to join our networks!