GreenED

The pursuit of sustainability in healthcare is an investment in the health of our patients, our community and our planet. Through embedding sustainable practices in our daily operations such as reducing the use of consumable items, choosing greener pharmaceutical supplies and looking for opportunities to improve our carbon footprint we can save money whilst improving our care for patients and the environment.

We are working towards the Royal College of Emergency Medicine’s Bronze GreenED Award in partnership with the GreenED Team in Derriford who have achieved this. A South West Sustainable ED group is being established; if you would like to join our team please contact our Sustainability Lead, Dr Toby Bateson by filling in the form at the bottom of the page.

We have reduced our cannulation rates and are in the process of introducing dry powder inhalers. Entonox use has been reduced significantly and the team are working to eliminate it from the department. We are looking for help with the other actions in the poster; please contact us if you would like to join in. Please click the ‘GreenED Opportunities’ Button to find out more.

Resources

Presentation On Sustainability In Emergency Medicine

Royal Cornwall Hospitals NHS Trust Green Plan 2025-2028

Previous QIPs and Initiatives

Reduction In Cannulation Quality Improvement Project

Our QIP to Reduce the Rate of Cannulation in the Emergency Department had many potential benefits. The primary reason for carrying this out was from a sustainability point of view. Many cannulae go unused and there is a wasted carbon footprint for each. As well as this, there is a measurable morbidity and mortality associated with cannulation in general with thrombophlebitis leading to illness and prolonged length of stay. Other benefits included reducing nursing and other clinician time for fitting the cannula, financial cost and patient discomfort. 

Data Summary From 2023

163 records looked at 

56 (34%)cannulated 

75  (46%) not cannulated 

31 (19%) notes not scanned/no cannula care plan 

One  set of notes not looked at due to patient confidentiality 

Cannulated 

RATS/Majors/Resus  40 (85% of patients going through RATS) 

Minors 15 (23% of patients going through minors) 

Paeds 1 (6%) 

Of those cannulated  

13 (23%) were inappropriate/not used. (9 RATS, 1 paeds, 3 minors).  

12 (21%) no data recorded/notes not scanned etc 

31 (55%) appropriate 

Based on estimated 175k attendances, CQC report sept 2020 to aug 2021 demonstrated 167k attendances. This gives an approximate number of cannulated patients of 59,500, of whom 13,685 were inappropriate/not used. Reported incidence of thrombophlebitis varies wildly from 1% to 90% but a few sources state 5% to be be a generally acceptable rate. This gives the number of avoidable cases as 684 per year.

61g of waste per cannulation episode (according to Carbon Footprinting Workshop from The Centre For Sustainable Healthcare) with a cost of £1.80.

Carbon conversion factor:

Medical/surgical equipment: 0.46kgCO2e/£

This gives a carbon footprint of 0.83kgCO2e per cannula and the footprint of a years’ unnecessary cannulation at 11,331kgCO2e per year!

Interestingly - when comparing this with other studies, we are already below the cannulation rate of many places even post their QI project of reducing cannulation. 

Salbutamol aerosol inhalers are a significant source of greenhouse gases. Each one is equivalent to driving 175 miles in a standard family car. A dry powder inhaler is pharmacologically equivalent but is equivalent to driving only 4 miles. They can be used in many of the situations where we will be issuing inhalers in the Emergency Department. We are not currently using DPI inhalers, and I initiated a Quality Improvement Project to check whether this is the right thing for the patients and for the environment and to give a structured approach to how to educate staff and patients, as well as to find out how well the introduction will be received. 

We are currently close to introducing the new inhalers and have been working closely with pharmacy and the asthma nurses to facilitate this. This is a great example of multidisciplinary working to the benefit of both the patients and the environment.  

Salbutamol QI Proposal Document 

Poster 

Presentation

Reduction in the Use of Entonox

Entonox is a greenhouse gas which has 298 times the warming potential of CO2. It has a half life in the atmosphere of around 150 years. Penthrox is a much better analgesic and is 0.84 times as warming than CO2, as well as breaking down in the atmosphere in 5-10 years. Entonox is now only available on a named patient basis and we have a protocol for using Penthrox in children. (Documentation to follow).

Ambulance Hookups

We are lucky enough to have ambulance hookups in the bays outside ED, this means the ambulances don’t need tube idling to have power on whilst they are waiting. If you see one with the engine on whilst they are waiting please ask them about it!

Derriford ED’s GreenED Bronze Award Document

Reducing Screen Brightness And Standby Time To Reduce Departmental Power Consumption

Powerpoint presentation