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Delivering a net zero National Health Service: where does otorhinolaryngology – head and neck surgery stand?

Published online by Cambridge University Press:  05 October 2023

Dimitrios Spinos Open the ORCID record for Dimitrios Spinos [Opens in a new window] ,
Jayesh Doshi  and
George Garas Open the ORCID record for George Garas [Opens in a new window]
Dimitrios Spinos*
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Gloucestershire Hospitals NHS Foundation Trust, Department of Otolaryngology, Gloucester, UK
Jayesh Doshi
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
George Garas
Affiliation:
Head & Neck Surgical Oncology Unit, Department of Otorhinolaryngology – Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK Surgical Innovation Centre, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
*
Corresponding author: Dimitrios Spinos; Email: dimitrios.spinos@nhs.net
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Abstract

Objective

The National Health Service (NHS) recognised the risk to public health brought by climate change by launching the Greener NHS National Programme in 2020. These organisational changes aim to attain net zero direct carbon emissions. This article reviews the literature on initiatives aimed at mitigating the environmental impact of ENT practice.

Method

Systematic review of the literature using scientific, healthcare and general interest (public domain) databases.

Results

The initiatives reviewed can be broken down into strategies for mitigating the carbon footprint of long patient stay, use of operative theatres and healthcare travel. The carbon footprint of in-patient stay can be mitigated by a shift towards day-case surgery. The ENT community is currently focused on the reduction of theatre waste and the use of disposable instruments. Furthermore, supply chains and healthcare delivery models are being redesigned to reduce travel.

Conclusion

Future areas of development include designing waterless theatre scrubs, waste-trapping technologies for anaesthetic gases and a continuing investment in virtual healthcare.

Keywords

Otorhinolaryngologycarbon footprintenvironmentpreventive medicinepublic health
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 138 , Issue 4 , April 2024 , pp. 373 - 380
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dimitrios Spinos takes responsibility for the integrity of the content of the paper

References

Public sector annual reports: sustainability reporting guidance 2020 to 2021. In: https://www.gov.uk/government/publications/public-sector-annual-reports-sustainability-reporting-guidance-2021-to-2022 [31 October 2022]Google Scholar
Delivering a net zero NHS. In: https://www.england.nhs.uk/greenernhs/a-net-zero-nhs/ [31 October 2022]Google Scholar
System progress. In: https://www.england.nhs.uk/greenernhs/whats-already-happening/ [3 November 2022]Google Scholar
Aldoori, J, Hartley, J, MacFie, J. Sustainable surgery: in and out of the operating theatre. Br J Surg 2021;108:e219–20CrossRefGoogle ScholarPubMed
MacNeill, AJ, Lillywhite, R, Brown, CJ. The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems. Lancet Planet Health 2017;1:e381–8CrossRefGoogle ScholarPubMed
Sustainability in Surgery. In: https://www.rcseng.ac.uk/about-the-rcs/about-our-mission/sustainability-in-surgery/ [30 October 2022]Google Scholar
What Otolaryngologists Can Do to Lessen Their Carbon Footprint. In: https://www.enttoday.org/article/what-otolaryngologists-can-do-to-lessen-their-carbon-footprint/ [3 November 2022]Google Scholar
Page, MJ, McKenzie, JE, Bossuyt, PM, Boutron, I, Hoffmann, TC, Mulrow, CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71CrossRefGoogle ScholarPubMed
Tennison, I, Roschnik, S, Ashby, B, Boyd, R, Hamilton, I, Oreszczyn, T et al. Health care's response to climate change: a carbon footprint assessment of the NHS in England. Lancet Planet Health 2021;5:e84–92CrossRefGoogle ScholarPubMed
Marshall, A. Getting it Right First Time Report: Ear, Nose and Throat Surgery. In: https://gettingitrightfirsttime.co.uk/wp-content/uploads/2019/10/ENT-Report-Nov19-L-FINAL.pdfGoogle Scholar
Pezier, T, Stimpson, P, Kanegaonkar, R, Bowdler, D. Ear, nose and throat day-case surgery at a district general hospital. Ann R Coll Surg Engl 2009;91:147–51CrossRefGoogle Scholar
Navaratnam, AV, Pendolino, AL, Andrews, PJ, Saleh, HA, Hopkins, C, Randhawa, PS et al. Safety of day-case endoscopic sinus surgery in England: an observational study using an administrative dataset. Clin Otolaryngol 2023;48:191–9CrossRefGoogle ScholarPubMed
Rizan, C, Steinbach, I, Nicholson, R, Lillywhite, R, Reed, M, Bhutta, MF. The carbon footprint of surgical operations: a systematic review. Ann Surg 2020;272:986–95CrossRefGoogle ScholarPubMed
Rizan, C, Lillywhite, R, Reed, M, Bhutta, MF. The carbon footprint of products used in five common surgical operations: identifying contributing products and processes. J R Soc Med 2023;116:199–213CrossRefGoogle ScholarPubMed
Devlin-Hegedus, JA, McGain, F, Harris, RD, Sherman, JD. Action guidance for addressing pollution from inhalational anaesthetics. Anaesthesia 2022;77:1023–9CrossRefGoogle ScholarPubMed
Faculty of Public Health. In: k9-fph-sig-nhs-carbon-footprint-final.pdf [12 December 2022]Google Scholar
McGowan, LS. Reducing the carbon footprint of anesthesia: low-flow anesthesia and other techniques. AANA J 2022;90:253–62Google ScholarPubMed
Jegatheeswaran, L, Oungpasuk, K, Choi, B, Nakhoul, M, Gokani, S, Espehana, A et al. Disposable versus reusable fibre-optic nasendoscopes: a national survey of UK ENT surgical trainees and a single-centre cost-analysis. J Laryngol Otol 2022;1–7 [Q2023 Aug;137(8):866-872]Google Scholar
Farrell, E, Smyth, D. The environmental impact of personal protective equipment in a pre and post COVID era in the ENT clinic. Eur Arch Otorhinolaryngol 2021;278:5051–8CrossRefGoogle Scholar
Great Ormond Street Hospital – reducing single use plastics case study. In: https://www.england.nhs.uk/greenernhs/whats-already-happening/great-ormond-street-hospital-reducing-single-use-plastics-case-study/ [4 November 2022]Google Scholar
Wyssusek, KH, Foong, WM, Steel, C, Gillespie, BM. The gold in garbage: implementing a waste segregation and recycling initiative. AORN J 2016;103:316.e1–8CrossRefGoogle ScholarPubMed
Lui, JT, Rudmik, L, Randall, DR. Reducing the preoperative ecological footprint in otolaryngology. Otolaryngol Head Neck Surg 2014;151:805–10CrossRefGoogle ScholarPubMed
Ryan, MT, Malmrose, J, Riley, CA, Tolisano, AM. Operating room waste generated across otolaryngology cases. Mil Med 2021;usab548Google ScholarPubMed
Sanabria, A, Kowalski, LP, Nixon, IJ, Shaha, A, De Bree, R, Mäkitie, AA et al. Considerations for environmentally sustainable head and neck surgical oncology practice. Am J Otolaryngol 2020;41:102719CrossRefGoogle ScholarPubMed
Ho, YH, Wang, YC, Loh, EW, Tam, KW. Antiseptic efficacies of waterless hand rub, chlorhexidine scrub, and povidone-iodine scrub in surgical settings: a meta-analysis of randomized controlled trials. J Hosp Infect 2019;101:370–9CrossRefGoogle ScholarPubMed
Energy use and water consumption final.pdf. In: Royal College of Anaesthetists: https://www.rcoa.ac.uk [23 October 2022]Google Scholar
Solar power sparks an electrical future for Milton Keynes University Hospital In: https://www.england.nhs.uk/greenernhs/whats-already-happening/solar-power-sparks-an-electrical-future-for-milton-keynes-university-hospital/#:~:text=The20Trust20has20approved20a,in20energy20bills20per20year. [6 November 2022]Google Scholar
Garas, G, Tolley, N. Robotics in otorhinolaryngology – head and neck surgery. Ann R Coll Surg Engl 2018;100:34–41CrossRefGoogle ScholarPubMed
Perry, H, Reeves, N, Ansell, J, Cornish, J, Torkington, J, Morris, DS et al. Innovations towards achieving environmentally sustainable operating theatres: a systematic review. Surgeon 2023;21:141–51CrossRefGoogle ScholarPubMed
Improving outcomes in head and neck cancers. In: https://www.nice.org.uk/guidance/csg6 [29 October 2022]Google Scholar
Sood, T, Supriya, M, Thopil, J, Surendra, V, Patel, BB. One stop neck lump clinic: a boon for quick diagnosis and early management. Eur Arch Otorhinolaryngol 2021;278:4951–4CrossRefGoogle Scholar
Elliott, M. Neck lump clinics: improving time to treatment. ANZ J Surg 2019;89:795CrossRefGoogle ScholarPubMed
Al Hamarneh, O, Liew, L, Shortridge, RJ. Diagnostic yield of a one-stop neck lump clinic. Eur Arch Otorhinolaryngol 2013;270:1711–14CrossRefGoogle ScholarPubMed
Forner, D, Purcell, C, Taylor, V, Noel, CW, Pan, L, Rigby, MH et al. Carbon footprint reduction associated with a surgical outreach clinic. J Otolaryngol Head Neck Surg 2021;50:26CrossRefGoogle ScholarPubMed
Mallick, S, Balakumar, R, Drysdale, A. Telephone clinic outcomes during the coronavirus disease 2019 pandemic: results from an ENT department. J Laryngol Otol 2022;136:611–14CrossRefGoogle ScholarPubMed
Sargsyan, N, Karunaratne, D, Masani, A, Howell, L, Yousif, M. ENT telephone clinics during the coronavirus pandemic: an analysis of 400 telephone consultations at a district general hospital. Ear Nose Throat J 2021;102:733–8CrossRefGoogle Scholar
Zammit, M, Siau, R, Williams, C, Hussein, A. Patient satisfaction from ENT telephone consultations during the coronavirus disease 2019 pandemic. J Laryngol Otol 2020;1–6CrossRefGoogle Scholar
Tselapedi-Sekeitto, B, Rocha, T, Sowerby, LJ, Rotenberg, B, Biadsee, A. Telemedicine as an environmental ally – The social, financial, and environmental impact of virtual care in the otolaryngology clinic. Am J Otolaryngol 2023;44:103791CrossRefGoogle ScholarPubMed
Malik, R, Abbas, JR, Jayarajah, C, Bruce, IA, Tolley, N. Mixed reality enhanced otolaryngology case-based learning: a randomized educational study. Laryngoscope 2023;133:1606–13CrossRefGoogle ScholarPubMed
Babylon Health. Babylon Health UK - The Online Doctor and… In: eMed, https://www.babylonhealth.com [23 December 2022]Google Scholar
Babylon Disrupted the UK's Health System. Then It Left. In: https://www.wired.co.uk/article/babylon-disrupted-uk-health-system-then-left [23 December 2022]Google Scholar
Pedal power for cleaner healthcare delivery. In: https://www.england.nhs.uk/greenernhs/whats-already-happening/pedal-power-for-cleaner-healthcare-delivery/#:~:text=The20impact&text=Using20e2Dbikes20has20allowed,nurse20arriving20on20a%20bicycle [30 October 2022]Google Scholar
Boosting healthy and sustainable travel in Manchester. In: https://www.england.nhs.uk/greenernhs/whats-already-happening/boosting-healthy-and-sustainable-travel-in-manchester/#:~:text=An20ambitious20sustainable20travel20plan,other20forms20of20active20travel [30 October 2022]Google Scholar
Zooming into a greener future: the case for a zero-emissions courier services. In: https://www.england.nhs.uk/greenernhs/whats-already-happening/zooming-into-a-greener-future-the-case-for-a-zero-emissions-courier-services/ [30 October 2022]Google Scholar
Green transport delivers life-saving drugs and improves patient experience. In: https://www.england.nhs.uk/greenernhs/whats-already-happening/green-transport-delivers-life-saving-drugs-and-improves-patient-experience/ [30 October 2022]Google Scholar
How The NHS Are Leading The Change Towards Electric Vehicles. In: https://www.epowertrucks.co.uk/news/how-the-nhs-are-leading-the-change-towards-electric-vehicles/ [27 December 2022]Google Scholar
Weatherby, T, Somner, J. Promoting electric vehicle uptake, a job for the NHS? Clin Med (Lond) 2019;19:534Google ScholarPubMed
Pandit, JJ. The NHS Improvement report on operating theatres: really ‘getting it right first time’? Anaesthesia 2019;74:839–44CrossRefGoogle ScholarPubMed
NHS faces huge loss of time and money from cancelled surgery. In: https://www.publicfinance.co.uk/news/2017/05/nhs-faces-huge-loss-time-and-money-cancelled-surgery [14 December 2022]Google Scholar
About NCEPOD. Non-elective surgery in the NHS. In: https://www.ncepod.org.uk/2003report/Downloads/03_s07.pdf [6 November 2022]Google Scholar
Gray, A. United Kingdom national confidential enquiry into perioperative deaths. Minerva Anestesiol 2000;66:288–92Google ScholarPubMed
Garas, G, Cingolani, I, Panzarasa, P, Darzi, A, Athanasiou, T. Network analysis of surgical innovation: measuring value and the virality of diffusion in robotic surgery. PLoS One 2017;12:e0183332CrossRefGoogle ScholarPubMed
Waberski, AT, Espinel, AG, Reddy, SK. Anesthesia safety in otolaryngology. Otolaryngol Clin North Am 2019;52:63–73CrossRefGoogle ScholarPubMed
Blue-Zone Technologies | Deltasorb® & Centralsorb® Waste Anesthetic Gas Systems. In: https://www.blue-zone.com/ [4 November 2022]Google Scholar
Nix, P. Prions and disposable surgical instruments. Int J Clin Pract 2003;57:678–80CrossRefGoogle ScholarPubMed
Zero carbon surgery. In: https://www.uhb.nhs.uk/news-and-events/news/sustainable-surgery-the-first-net-zero-operation-in-the-nhs/608186#:~:text=A20surgical20team20at20University,to20remove20a20bowel20cancer [31 October 2022]Google Scholar
ENT UK Statement: Sustainable Healthcare In ENT. In: https://www.entuk.org/news_and_events/news/264/ent_uk_statement_sustainable_healthcare_in_ent/#:~:text=ENT20UK20recognises20the20need,Excellence20and20Shaping20the20Future [7 May 2023]Google Scholar
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