"[This project] emerged from the simple observation by the theatre team that at least 1-2 cataract surgery cases per week were being converted from GA to LA on the day of surgery. In addition to the use of environmentally harmful anaesthetic gases, GA patients require more hospital visits, additional investigations & longer hospital stays. General anaesthesia is also associated with higher risks than local. It was felt that the decision for type of anaesthetic should be made earlier on in the pathway and with a greater focus on improved patient engagement.
The project was an awe-inspiring team effort which involved the whole ophthalmology team including clinicians, pre-op assessment nurses, theatre nurses, operating department practitioners (ODPs), anaesthetists and of course the patients. The team also had support from CSH to help calculate the impact of the project.
The impact the project had on the triple bottom line and the opportunity to introduce the principles of SusQI were possibly what gave us the winning edge in the Green ward competition. Rates of GA in cataract surgery are low but they can be reduced further and deliver wider benefits, as was demonstrated by the project. There was a significant reduction in CO2 emissions as a result of less waste and not using harmful anaesthetic gases and a substantial financial saving of £162K per annum due to the reduced cost of equipment, workforce & investigations.
Looking at social sustainability, patients benefitted from improved engagement and shared decision making, fewer disruptive visits to hospital for pre-operative assessments, and leaving hospital earlier – as less time was needed in recovery after an LA.
Staff benefitted from working together as a team towards a common goal and from the empowerment of being able to lead the transformation. Clinical outcomes were not measured, but there were perceived benefits relating to reduced risks from GA, reduced waiting time due to the streamlined pathway and a reduced risk of Covid transmission as GA is an aerosol generating procedure.
A key take home message is that there are plenty of opportunities for sustainable healthcare solutions and by empowering the people on the ground you can be very successful in making a difference."
Read the full article on this project, "Keeping an Eye on Sustainability" on the Barts Health Website.
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