Case studies

The Trust held a Green Ward competition where a number of clinical teams identified projects that had potential for environmental or social improvement within their area and worked in partnership with the Centre for Sustainable Healthcare to improve environmental sustainability and reduce our carbon footprint. 

The winners were Katy Mallender-Ward and Christine McNally from Radiology who have been working with their team on an initiative which reduces unnecessary visits by patients who are referred for an x-ray by their GP.  Every referral is vetted by a member of the team who confirms whether the patient needs to attend.

This prevents inappropriate referrals and patients being turned away, therefore saving them and the department time, as well as reducing the carbon footprint. 

Read the Green Ward case study

The team on the Intensive Care Unit at St James's Hospital have taken part in an improvement project to improve waste segregation and recycling.

Clinical waste creates a number of challenges due to legislation, and the team have looked at new and innovative processes as well as alternative recycling bins and bags to support this.

The results so far have been very promising, with a significant increase in the amount of recycling on the unit, and better segregation between domestic and offensive waste which also creates a cost saving for the Trust.

Education has been key to their success - the more staff who have received training or briefings, the better their waste segregation and recycling.

The overall ambition, alongside recycling as much waste as possible, is to create a model that can be rolled out to other clinical areas in the future, contributing to our ambition of being one of the greenest Trusts in the country.

The trust has been working to reduce use of the most environmentally damaging anaesthetic gases to help meet its carbon reduction aims. 

Desflurane, an inhalational agent used in anaesthesia, was responsible for 87% of the trust’s carbon dioxide equivalent emissions resulting from the use of anaesthetic gases.

Anaesthetists were asked to substitute it, wherever clinically appropriate, with sevoflurane, a less damaging agent in terms of CO2 equivalent emissions (9% of total CO2 equivalent (tCO2e) emissions from anaesthetic gases), which has a significant cost saving for each bottle.

The key intervention was to incorporate an environmental section into one of the regular conferences held by anaesthetists. This discussed environmental and potential clinical impacts, potential cost savings, and contribution to the trust’s overall sustainability agenda. All stakeholders, including pharmacy, estates, and facilities, were consulted. The anaesthetists agreed to default to using sevoflurane, except where desflurane was considered advantageous according to clinical judgment.

Use of desflurane has significantly decreased since the intervention. Monthly emissions have fallen considerably, down to 187 tCO2e in January 2020 compared with 517 tCO2e in January 2019. 

Adam Newman, sustainability manager, said, “So far the feedback has been positive. The cost to pharmacy has gone down and there have been no medical repercussions arising from the change in use of anaesthetic gas. Assuming the success of the project continues, it will become ingrained behaviour and will be sustainable over the long term.”

This project was shortlisted for a BMJ award 2020.

The issue:

From 2019 to 2020, the Leeds Teaching Hospitals NHS Trust used nearly 700 Harmonic ultrasonic scalpels. These devices are used in a host of laparoscopic procedures across many specialities to simultaneously cut and cauterise tissue. The devices are single-use and must be disposed of after each procedure. 

The Trust is committed to reducing waste and hasn't sent any general or offensive waste to landfills for over five years. Clinical waste such as Harmonic scalpels has to be disposed of by high temperature incineration. However, the Trust’s Abdominal Medicine and Surgery Clinical Service Unit and Theatre teams were keen to investigate new processes and technologies to further reduce waste and the environmental impact of clinical procedures.

The solution:

Remanufacturing is the process of taking a single-use device and making it reusable. Vanguard Medical Remanufacturing is a leading European remanufacturer of medical devices, and they currently supply the Trust with remanufactured EP catheters. 

Through discussions with the Trust's clinical teams and Vanguard, it became apparent that using Vanguard's Harmonic Remanufacturing Programme would reduce the waste and environmental impact of these devices. 

The first step was to establish the process, which involves Vanguard collecting the used devices from the Trust's theatres after a procedure and taking them to their factories for cleaning and checking before being re-sterilised.  Remanufactured Vanguard devices are supplied to the Trust at a price that is significantly less than purchasing a new product.

The impact:

To date, the implementation of the collection process and the use of the remanufactured equipment has been a great success. 

Mr Jeremy D Hayden, Lead Clinician for Oesophageal, Gastric and Pancreatic Surgery and Consultant Upper GI & Bariatric Surgeon is quoted saying: "Consultant GI surgeons are increasingly adopting this as part of their routine practice and considerable savings have been made and contributed to the Trust's waste reduction programme.

"The Trust is hoping to see an expansion in the use of other remanufactured devices to support a more sustainable working environment and reduce costs."

The Trust has estimated that waste has been reduced by 38kgs, with CO2emissions reduced by 100kgs. They are currently operating on a 50:50 split between the original and remanufactured devices. 

What's next?

Moving forward, the Trust will look to further explore the introduction of remanufactured devices and reverse logistic options, to reduce the carbon footprint of clinical procedures. This will involve working with Vanguard and other remanufactured device suppliers to highlight other single-use devices that could be repurposed.