Streamlining carpal tunnel release surgery

Setting/Patient Group: 2 hospital sites 

Issue to be addressed:

To reduce the carbon footprint of carpal tunnel release (CTR) surgery by

1. Adapting a “lean and green theatre set up” by reducing the number of single use instruments, trays and drapes used per procedure
2. Transforming to a “Green CTR patient pathway” by utilizing a minor procedure room (instead of theatre) and therefore bypassing the pre-theatre ward admission process.

Intervention:

1. A green patient pathway was proposed for elective day case hand surgery under local anaesthetic in minor procedure room”
2. Streamlined ‘minor hand procedure’ sets were agreed on and large generic limb drapes were replaced with two small 90cm square drapes.
3. Use of a minor procedures room instead of a theatre was approved.
4. Four pilot Lean and Green Hand Surgery lists involving seventeen patients utilising interventions above took place June - July 2021.

Outcome:

Clinical

• Positive patient outcomes included; reduced length of stay, reduced theatre list and surgical wait times.

Social

• More streamlined and enjoyable patient and staff journey.
• Less clinical pressure by removing theatre usage.

Environmental

• Changing to a “Lean and Green” set up demonstrated a 31kg CO2 reduction per case. This is an 80% reduction of the carbon footprint

Economic

• Changing to a “Lean and Green” set up demonstrated a £33.71 reduction per case. This is a 65% reduction of the total cost

Key learning point

This project demonstrated that a lean theatre set up and green patient pathway can deliver a safe, efficient, cost-effective and sustainable hand surgery service within an orthopaedic department.