Improving sustainability and mitigating the environmental impact of anaesthesia and surgery along the perioperative journey: a narrative review.

Climate change, environmental degradation, and biodiversity loss are adversely affecting human health and exacerbating existing inequities, intensifying pressures on already strained health systems. Paradoxically, healthcare is a high-polluting industry, responsible for 4.6% of global greenhouse gas emissions and a similar proportion of air pollutants.

Improving Environmental Sustainability of Operating Theatres: A Systematic Review of Staff Attitudes, Barriers, and Enablers.

Objective: To understand views of staff in relation to attitudes, enablers, and barriers to implementation of environmentally sustainable surgery in operating theatres. This will ultimately help in the goal of successfully implementing more sustainable theatres.

Background: Global health care sectors are responsible for 4.

Environmental impact of hybrid (reusable/single-use) ports versus single-use equivalents in robotic surgery.

Given the rise in robotic surgery, and parallel movement towards net zero carbon, sustainable healthcare systems, it is important that the environmental impact of robotic approaches is minimised. The majority of greenhouse gas emissions associated with robotic surgery have previously been associated with single-use items. Whilst switching from single-use products to hybrid equivalents (predominantly reusable, with a small single-use component) has previously been found to reduce the environmental impact of a range of products used for laparoscopic surgery, the generalisability of this to robotic surgery has not previously been demonstrated.

Country of Origin of Medical Products and Risk of Labour Rights Abuse: A Cross-Sectional Analysis Using Four Procurement Datasets.

Background Case studies have highlighted labour rights abuse in the manufacture of several healthcare products, but little is known about the scale of the problem or the specific products involved. We aimed to quantify and compare the overall and product-specific risks of labour rights abuse in the manufacture of healthcare products supplied to high-income settings using multiple datasets on the product country of origin (COO). Methods Public procurement data from South-Eastern Norway (n=23,972 products) were compared to datasets from three other high-income settings: procurement data from Cambridge University Hospitals, trade data from UN Comtrade, and registry data from the US Food and Drug Administration (FDA).

Patient, hospital and environmental costs of unnecessary bloodwork: capturing the triple bottom line of inappropriate care in general surgery patients.

Objective: To characterise the extent of unnecessary care in general surgery inpatients using a triple bottom line approach.

Design: Patients with uncomplicated acute surgical conditions were retrospectively evaluated for unnecessary bloodwork according to the triple bottom line, quantifying the impacts on patients, healthcare costs and greenhouse gas emissions. The carbon footprint of common laboratory investigations was estimated using PAS2050 methodology, including emissions generated from the production, transport, processing and disposal of consumable goods and reagents.

The carbon footprint of products used in five common surgical operations: identifying contributing products and processes.

Objectives: Mitigating carbon footprint of products used in resource-intensive areas such as surgical operating rooms will be important in achieving net zero carbon healthcare. The aim of this study was to evaluate the carbon footprint of products used within five common operations, and to identify the biggest contributors (hotspots).

Design: A predominantly process-based carbon footprint analysis was conducted for products used in the five highest volume surgical operations performed in the National Health System in England.

HealthcareLCA: an open-access living database of health-care environmental impact assessments.

Anthropogenic environmental change negatively effects human health and is increasing health-care system demand. Paradoxically, the provision of health care, which itself is a substantial contributor to environmental degradation, is compounding this problem. There is increasing willingness to transition towards sustainable health-care systems globally and ensuring that strategy and action are informed by best available evidence is imperative.

Minimising carbon and financial costs of steam sterilisation and packaging of reusable surgical instruments.

Background: The aim of this study was to estimate the carbon footprint and financial cost of decontaminating (steam sterilization) and packaging reusable surgical instruments, indicating how that burden might be reduced, enabling surgeons to drive action towards net-zero-carbon surgery.

Methods: Carbon footprints were estimated using activity data and prospective machine-loading audit data at a typical UK in-hospital sterilization unit, with instruments wrapped individually in flexible pouches, or prepared as sets housed in single-use tray wraps or reusable rigid containers. Modelling was used to determine the impact of alternative machine loading, opening instruments during the operation, streamlining sets, use of alternative energy sources for decontamination, and alternative waste streams.

Environmental impact and life cycle financial cost of hybrid (reusable/single-use) instruments versus single-use equivalents in laparoscopic cholecystectomy.

Background: Hybrid surgical instruments contain both single-use and reusable components, potentially bringing together advantages from both approaches. The environmental and financial costs of such instruments have not previously been evaluated.

Methods: We used Life Cycle Assessment to evaluate the environmental impact of hybrid laparoscopic clip appliers, scissors, and ports used for a laparoscopic cholecystectomy, comparing these with single-use equivalents.

Environmental impact of personal protective equipment distributed for use by health and social care services in England in the first six months of the COVID-19 pandemic.

Objective: To quantify the environmental impact of personal protective equipment (PPE) distributed for use by the health and social care system to control the spread of SARS-CoV-2 in England, and model strategies for mitigating the environmental impact.

Design: Life cycle assessment was used to determine environmental impacts of PPE distributed to health and social care in England during the first six months of the COVID-19 pandemic. The base scenario assumed all products were single-use and disposed of via clinical waste.

A Blueprint for Streamlining Patient Pathways Using a Hybrid Lean Management Approach.

Background: Streamlining patient pathways within health care systems is a complex and challenging process. While frontline clinicians often have an abundance of ideas, these rarely translate into real-world change due to nonadoption or early abandonment.

Objectives: The aim of this article is to provide frontline clinicians with a blueprint for developing a business case for a streamlined pathway while guiding the practical implementation of this blueprint.

Why are UK junior doctors taking time out of training and what are their experiences? A qualitative study.

Objectives: The number of doctors directly entering UK specialty training after their foundation year 2 (F2) has steadily declined from 83% in 2010 to 42.6% in 2017. The year following F2, outside the UK training pathway, is informally termed an 'F3' year.

General surgeon's antibiotic stewardship: Climbing the Rogers Diffusion of Innovation Curve-Prospective Cohort Study.

Introduction: The primary aim of this study was to establish concordance of general surgeon's prescribing practice with local IV-oral antibiotic guidelines. The secondary aim was to evaluate the effect of introducing educational antibiotic measures. The Rogers Diffusion of Innovation Model was used to explore the adoption of antibiotic stewardship practices.

Post-sinus surgery insertion of steroid-eluting bioabsorbable intranasal devices: A systematic review.

Objectives/hypothesis: Postendoscopic sinus surgery corticosteroid administration reduces polyp formation, inflammation, and adhesions. Steroid-eluting bioabsorbable intranasal devices (SEBID) are novel interventions thought to improve local drug delivery while minimizing systemic side effects. The primary aim of this systematic review is to evaluate the efficacy and safety of bioabsorbable SEBIDs.

Feedback in action within bedside teaching encounters: a video ethnographic study.

Context: Feedback associated with teaching activities is often synonymous with reflection on action, which comprises the evaluative assessment of performance out of its original context. Feedback in action (as correction during clinical encounters) is an underexplored, complementary resource facilitating students' understanding and learning.

Objectives: The purpose of this study was to explore the interactional patterns and correction modalities utilised in feedback sequences between doctors and students within general practice-based bedside teaching encounters (BTEs).

Can endoscopists accurately self-assess performance during simulated colonoscopic polypectomy? A prospective, cross-sectional study.

Background: The aim of this study was to establish if endoscopists can reliably self-assess their ability to perform simulated colonic polypectomy.

Methods: Novices, intermediates, advanced, and experts performed a video-recorded polypectomy task using the Welsh Institute for Minimal Access Therapy (WIMAT) colonoscopy suitcase simulator. This involved removal of a simple polyp (A) and a complex polyp (B).

The Welsh Institute for Minimal Access Therapy colonoscopy suitcase has construct and concurrent validity for colonoscopic polypectomy skills training: a prospective, cross-sectional study.

Background: The Welsh Institute for Minimal Access Therapy (WIMAT) colonoscopy suitcase is an ex vivo porcine simulator for polypectomy training.

Objective: To establish whether this model has construct and concurrent validity.

Design: Prospective, cross-sectional study.