Case Report Archive


Small steps can make big impacts – Cool sticks at Northumbria NHS Trust


Small steps can make big impacts. The team at Northumbria targeted Ethyl Chloride, the topical anaesthetic and greenhouse gas, that is used to test sensory block height in theatres and labour ward. They introduced metallic cool-sticks and demonstrated significant reductions in environmental and financial impact.

Authors: Joshua Craig, Zoe Robertson, Elaine Winkley

Contact: [email protected]

Location: Northumbria NHS Foundation Trust

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NEASH Regional Inhalational Agent Audit


The region wide audit looked at the use of the gases around the area and found considerable interdepartmental variation. The results of this project have been presented at every centre in the region and was coupled with an education message regarding more sustainable alternatives such as TIVA (total intravenous anaesthesia) and sevoflurane.

Project Lead: Jordan Minns

Location: Regionwide

Regional Presentation

Primary Care

Pessary Power!


This fantastic SusQI project carried out by GP Registrar, Abby Lewis Barned, is a perfect example of a project that identified a sustainable alternative that creates less plastic waste and saves the NHS money without compromising patient care – triple whammy (bottom line).


Oestrogen pessaries are very commonly prescribed for the management of post-menopausal urogenital symptoms. The most commonly prescribed pessary is Vagifem, with each tablet coming with its own plastic applicator. A simple switch to Vagirux, that comes with a single, reusable applicator could save 15.6million plastic applicators from landfill each year.

Author: Abby Lewis-Barned

Contact: [email protected]

Case Report

Green Impact: Health Toolkit

Green Impact’s toolkit is a really effective way to incorporate sustainability actions into your GP practice. Jake Shepherd (GPST3) and the team at the Vilalge Surgery have recently achieved the Green Impact bronze award by implementing simple but effective changes, such as:

• Switching to recycled paper

• Reducing single use plastic by introducing wipeable aprons

• Reducing water use by using washing up bowls

• Working with pharmacy to reduce inappropriate polypharmacy

The Green Impact for Health toolkit is definitely worth checking out for practices that want to get on the Sustainability Express!

Sign your practice up today!


Maximising reusable surgical instrument use, including laparoscopic ports, for a sustainable appendicectomy pathway

Courtesy of, and with permission of Centre for Sustainable Healthcare


The team at Derriford Hospital, University Hospitals Plymouth NHS Trust, focused on reducing the consumption of single-use surgical equipment for their Green Surgery Challenge project.  Consumables account for one-third of surgical procedure-related emissions and so a reduction has the potential to make a significant impact on carbon emissions in their department and Trust.

Project Leads: Peter Labib, Bryony Ford

Location: Derriford Hospital Trust.

Further Information here

Reducing blood testing in the pre-operative work-up for laparoscopic cholecystectomy

Courtesy of, and with permission of Centre for Sustainable Healthcare


This project focused on streamlining the pre-operative pathway for elective surgery. The team aimed to reduce pathology testing  as this is the single highest volume clinical activity in the NHS and has the potential to have significant carbon savings.

Project Leads: Alyss Robinson, Shameen Jaunoo, Mansoor Khan

Location: University Hospitals Sussex NHS Foundation Trust.

Further information here

Sustainable Carpal Tunnel Surgery Pathway

Courtesy of, and with permission of Centre for Sustainable Healthcare


This fantastic project from Betsi Calwaladr University Health Board in North Wales focused on the carpal tunnel release pathway. They considered the whole pathway and chose interventions that would reduce the consumption of single-use surgical equipment and reduce energy use by moving out of the operating theatre, reducing size of autoclave trays by streamlining the reusable surgical sets and eliminating the need for ward admission.

Project Leads: Edwin Prash Jesudason, Preetham Kodmuri

Location: Betsi Calwaladr University Health Board, North Wales

Further information here

Substituting local for general anaesthesia for inguinal hernia repair and introducing reusable surgical gowns

Courtesy of, and with permission of Centre for Sustainable Healthcare


This team from Imperial College Healthcare NHS trust reduced the environmental and financial impact of inguinal hernia surgery by switching from general to local anaesthetic and by using reusable surgical gowns.

Project Leads: Jasmine Winter Beatty, Jonathan Gan

Location: Imperial College Healthcare NHS Trust

Further information here

Innovative sustainable laparoscopic appendicectomy pathway

Courtesy of, and with permission of Centre for Sustainable Healthcare


The Leeds Teaching Hospital NHS Trust team’s Green Surgery Challenge project included four components:

  1. Replacing CO2 insufflation with the RAIS device
  2. Changing from disposable to reusable gowns and drapes
  3. Replacing urinary catheterisation with pre-induction toileting
  4. Replacing single-use instruments with reusable instruments in the instrument tray for appendicectomy

Project Leads: Aaron Quyn, Adam Peckham-Cooper

Location: Leeds Teaching Hospital

Further information here


Workforce Sustainability Education and Training


This fantastic project from the team at CDDFT aimed to increase the update of sustainability training by the entire workforce. This was achieved by employing a number of simple, effective and reproducible steps that can easily be replicated across the region

Project Leads: Jillian Bailey, Richard Hixsom

Location CDDFT

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