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SusQI project completed at Derriford Hospital, University Hospitals Plymouth 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. 

Abstract

Reducing single-use surgical instruments during laparoscopic appendicectomy: Using sustainable quality improvement as a catalyst to encourage wider behavioural change in a surgical department.

Aims: To reduce the carbon footprint of laparoscopic appendicectomies whilst meeting the triple bottom line and instigate lasting behavioural change in the surgical department.

Method and measurement: We performed an audit of 25 consecutive appendicectomies to confirm which single-use instruments were routinely opened and review current practice. We proposed a revised appendicectomy set focused on replacing 5mm ports, 12mm ports, Johann, Maryland and scissors with reusables. We acquired a loan set reusable to trial. Costs of the five instruments were provided by the procurement team and annual cost was extrapolated by our audit data. Carbon footprint calculations were conducted using a bottom-up approach. Qualitative social benefit data was collated via staff surveys.

Results: We applied our audit results to represent the 500 laparoscopic appendicectomies performed annually. With an initial cost of £19,730.53 and 47.7 kg CO2e, investing in reusable will be cost neutral within six months (accounting for sterilisation and reusable lifespan). If purchasing reusable instruments reduced single-use instrument use by 75% (a conservative estimate), we expect to save £34,423 and 512kg CO2e per year.  Socially, over 90% of responders said they would now consider sustainability in their surgical practice and know who to contact if they have ideas to improve surgical sustainability.

Conclusion: We have successfully proposed an updated appendicectomy set that will significantly reduce the carbon footprint of laparoscopic appendicectomies whilst meeting the triple bottom line. We exceeded our second aim by bringing surgical sustainability onto the agenda with results disseminated beyond the surgical department. 

Authors: 

• Dr Bryony Ford, FY2 doctor
• Mr Peter Labib, ST6 general surgery registrar
• Mr Aditya Kanwar, consultant HPB surgeon
• Mr Grant Sanders, consultant oesophagogastric surgeon
• Mr Walter Douie, consultant colorectal surgeon
• Ms Michelle Winfield, senior sister and clinical procurement specialist

You can read more about the project by downloading the attached case study or at this link: Introducing Team 1 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