Enhancing Sustainability Value in Endoscopy at RUH Bath: Simple Switches and PPE Reduction’

Project completed as part of the RUH Bath Green Team Competition. 

Team members: Sister Anuska Glendinning-Cranch, Clinical   Endoscopist

Setting / patient group: Endoscopy

Issue: In healthcare, endoscopy is a major contributor to the environment footprint generating around 3.09kg of waste per bed per day (Maurice et al 2020). It is suggested that in the UK alone 2.1 million procedures were performed in 2019, Siau et al (2021,) therefore as a specialty we need to actively review and undertake actions to assist endoscopy services to become more sustainable. As a clinical Endoscopist the change review began at source, reviewing the procedures that I performed to try and identify any ‘small wins’ that could be achieved which led to the idea of switching linen sheets to paper couch roll during trans nasal endoscopy (TNE) procedures. A snowball effect immediately began as the idea was quickly expanded to the removal of pillowcases and incontinent (Inco) pads which are used prophylactically to protect the linen

Primary Aim: 
To reduce environmental waste (CO2e) and monetary costs of the endoscopy service, and improve sustainability mind set.

Intervention: 

• Removing the use of unnecessary linen that requires laundering off site 
• Removing the unnecessary use of Inco pads that are then placed into hazardous waste disposable bins
• To introduce tissue paper as an alternative that can be recycled post procedure 
• To introduce the ideas of sustainability in the Endoscopy department.
• To commence engagement with staff surrounding sustainability practices within the trust, namely PPE usage 

 Outcomes:

Patient Outcomes: The changes made are unlikely to impact patient outcomes, so not formally assessed. The impact of patient experience was considered and a random selection of patients were interviewed on their experience of comfort during procedure.

Environmental:By removing the use of an incopad, pillowcase and sheet and introducing couch roll, it's estimated that we’ll be saving 0.622 kgCO2e per procedure. Based on introducing this change to 100% of our TNE and OGD procedures, it’s estimated that we’ll save 1,747.0  kgCO2e per year. equal to: Driving 5,147 miles in an average care from Bath to Edinburgh 6.4 Times or Flying London to Glasgow and back 4.7 times

Financial:monetary savings per procedure and per annum based on a 100% switch = £2,160.68

Key learning point:

The intervention introduced within the project has started, albeit at a small-scale level, to assist in both aspects.  Reducing CO2 emissions yet in conjunction with financial gains due to re assessing how we practice everyday tasks is a small step in altering people’s mindset to the possibility of introducing change at any level.  The results gained from this intervention could in turn be reproduced within different departments.

It has demonstrated the concept that small ideas can lead to others and in so doing create a movement of change by realizing that we can all play a part in sustainability, not just within health care but in all aspects of our life.