Our story
Preetham Kodumuri, Consultant Orthopaedic Hand and Wrist Surgeon, Wrexham Maelor Hospital
I had always been mindful of the amount of waste generated by the simple operations that take place multiple times daily in hospitals across the world.
Four years ago when I completed my clinical training, myself, along with my colleague Edwin Jesudason, decided to look into what could be done to minimise waste, particularly in relation to carpal tunnel surgery - as it's the most common orthopaedic procedure in the UK.
Our thinking was based on the knowledge that operating theatres in the UK generate up to 70 per cent of hospital waste which, in cost terms, comes in at £2.8 billion pounds a year. What was concerning to us was that while the need is clearly for us to reduce waste, we were actually witnessing the opposite, with a steady rise in waste of 15 per cent annually due to the increase of the use of disposable materials.
Our aim was to demonstrate how we could reduce the carbon footprint of carpal tunnel surgery by using a leaner set of instruments, smaller drapes, a green patient pathway and the use of a small procedure room, rather than a traditional operating theatre.
The green patient pathway was focused on reducing the time a patient spends in hospital by lessening both the number of times they need to visit the hospital, and by drastically reducing the time they spend on site during the day of the procedure. In the past, a patient would arrive with us at 8am, we would begin the procedure at 10am, and they'd be on their way home at 1pm. We knew it was feasible to do it all in 30 minutes but no-one had ever questioned it. We were just continuing to do things the way they had always been done.
The pilot started in two hospitals with 17 patients across two sites and no complications. The feedback was that the patients received an excellent experience and the staff teams were highly positive too. All of this was also achieved against the challenging backdrop of the pandemic and any teething problems from the staff's perspective (most notably in terms of paperwork) were dealt with quickly and easily.
The new way of doing things means we can report a 65 per cent reduction in clinical waste, an 80 per cent reduction in our carbon footprint, and a 65 per cent in cost savings at the hospitals, which equates to £12,641 annually.
Other positives also mean that patients have a minimal stay in hospital, there is no need for ward admission, we can do more procedures overall, and by doing so, in dedicated procedure rooms, time was freed up in theatres for bigger surgical procedures.
Our advice
Be very clear about what you want to achieve – make sure it's a simple concept that people can understand and make sure that you have processes in place to measure its success. It also needs to be achievable too – otherwise you will not get the buy in from those around you.
You should also cast your net wide and leave no-one out. So many people are stakeholders. For us, it was everyone from patients to porters. You might be surprised who has the solution to any problems you are facing.
You will have setbacks along the way but don't stop. We had issues with the amount of paperwork staff needed to complete following the introduction of the green patient pathway. We looked at it and found a way to make it better for everyone. There is usually a solution.
You need both patience and persistence if you are going to affect change so don't be in a hurry. You have to realise that which is important to you isn't necessarily important to those around you, so you won't win them over with your argument alone. You have to find common ground. For us, we talked about cost savings, freeing up theatre time, and improved patient experience. You sell your idea by not just talking about what's in it for you, but what's in it for them.
Our metrics
We measure the volume of clinical waste generated by each procedure and are able to apply that to a carbon emissions calculation to work out the environmental impact.
