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Hello and welcome back, everybody, Um, hope you all had a nice time minute break. Next up, we've got a presentation from Mister Prostate, the Dayton who's a consult in orthopedic surgeon in That's the sequence of Bangor in North Wales. He's a consultant hand surgeon, an orthopedic surgeon on he on his team were one of the winners last year off the Send first Anal Healthcare's Green Surgery Challenge through massively reducing the carbon footprint off couple turtles in Drome, which is one of the procedures that Professor Butter related to earlier eso. Without further ado, I'm going to introduce this's presentation from Mr Edison about how to turn your sustainability ideas into reality. Good afternoon, everyone. My name is Edward Pressure Jason Nelson, known as pressure to my friends and colleagues. It's a great privilege and honor to be speaking to you at this photo sustainability virtual conference. I'm so pleased that sustainability has crept up the surgical agenda. I had the privilege off organizing the Wealth of Orthopedic Society meeting last year, which had a sustainability symposium in it. For the very first time last week, I was at the International Federation for Surgical Societies of the hand. Our biggest international hand meeting with 4000 delegates on there were two sustainable surgery. Symposia on the society will be releasing a sustainable sustainability statement later this year. So what I wanted to talk to you today about is just to share with you my experience on to give you some tips and tricks on how to facilitate change on to turn your sustainability ideas into reality. So my conversion event was the green Surgery Challenge. So this was a collaboration between the Royal College is on the center of sustainable healthcare on Do we in Bangor. Andan Wrexham in North Wales looked at a couple tunnel operation on in 20 21/10 weeks. By making some relatively small changes, we were able to demonstrate quite significant changes. 65% reduction in plastic waste, 80% reduction in carbon footprint, reduced consumables, reduced instrument processing increase, productivity, increased staff and patient satisfactions on, of course, financial savings. So two contextualized this we estimated that our green pathway could save the organization. At least 12,000 lbs a year on would save the equivalent carbon as driving 33,000 miles in a petrol vehicle. However, How do you demonstrate this is a good idea Now it's a no brainer to all of us. Now the picture on the left is how most of you will set up for a couple tunnel. Decompression is the way I've done the operation for 20 years to sponges a swab on a stick up to the elbow, two sheets under the hand board on enormous extremity trip from the fingers to the feet frequently thrown over the patient's face to freak him out even more. Onda. I used to talk okay for the 10 year 1st 10 years of my career, I never gave it a thought. That's the way it's always been done. What creatures of habit on me. So now this is my set up on the right hand side, I used to small 90 by 90 or 75 by 75 sheets know tornado. Okay, wide awake local anesthesia without tourniquet know light handles. I prepped with chlorhexidine through a spray bottle and let it dry. It's a fairly radical rethink, but when you see it like this, it just seems like common sense. However, you must demonstrate the change, like this is in everybody's interest. Let's look at the left. This is a North a PT cancer, which many your department's will use and have, and these are frequently open because we don't have enough minor handsets. It includes a plethora of instruments that I will never use. On the right is my carpal tunnel decompression set, which is used for most local anesthetic hand cases. Now I think our hospital has about six of these sets, but they're so popular they get open for many other procedures. Um, on the default is to open an orthopedic cancer if we don't have enough of these sets in circulation on the day of the surgery. But it's not easy, but you haven't uphill battle because you're fighting against habit you're fighting. It's dogma. Dogmatic assertions around patients safety, the evidence based health and safely sterility. Concerns on what I've learned also is that there are procurement arrangements in place for her drapes on extremity packs. Now the large extremity drapes in most hospitals will come prepackaged in an extremity pack, which usually has two or three large drapes to three small drapes and extremity draped with a hole in the middle on D. Often, some single use plastic. So, um, suction tubing on a few other bits and pieces on the hospital procured the's by the 1000 sometimes by the tens of thousands on. They're cheap. They're convenient. They're easy on D. The's extremity packs open for any extremity operation of the upper or lower limb. So changing this may create work for other people in the short term. Um, and you need to consider this. So the way to do this is to demonstrate viable alternative, show your colleagues and theaters a different way. And the best way to do this is to collaborate to bring them with you, make them part of the team. My the top tip would be to formalize any sustainability ideas you have. Contact your audit department, your quality improvement. Um, on registry. It's a quality improvement project. Um, bring with you your consultant colleagues, um, and your planet have it in your diary is part of your weekly plan trainings and students could be helpful. A symbiotic relationship to great for them. They get some project experience on we get an extra pair of hands to help us with, um, with the actual nitty gritty of data collection on the work itself on Look for national unload Kalinda vision projects. So I joined the Green Surgery Challenge, which I suspect what we run again. Uh, this year or next on this was undertaken by the center of Sustainable Healthcare. I also joined the Bevin Commission as an exemplar. Now the bed and commission is based in Wales. They're a government. They not the government body. But they're a think tank that advises the Welsh assembly on and the chest whales on health care innovation projects. And they were enormously helpful in getting this project off the ground. So these bodies will help you on give you that those of the resource is on leadership experience required to get off the ground. So how do you do it? So the way to do it is to make time, make time in your job. We all live busy lives on the's projects require some focus. So make time and you're working when you're working week to actually sit down, plan, coordinate and deliver this cetaphil working party in a group, which is what I did make friends identify all the green champions. Now, with regards my project, um, corridor conversations the operating theater lead to be identifying two or three people in terms of the theater nurses Ondo DP's who were particularly interested in particularly passionate about, um, improving, um, productivity and decreasing waste generation. And I brought these into my team on. We also brought on board the manager off the, uh, sterile services unit. He was hugely helpful with the procurement arrangements and the instrument processing a vengeance. And also, I would suggest, identify all the green champions within your hospital. Most hospitals. Now, we'll have a green group. Certainly in Wales, this is extremely popular on we have a whole green network off mean groups across North Wales on South Wales as well. On this be very helpful. Other colleagues from other disciplines and backgrounds can give you guidance support on Also, identify well the places to showcase your work. So make friends make time, make friends. The next thing I would say is make it financially attractive. Now, when you go to your managers with sustainability ideas, they'll be extremely interested. However, you must remember they're not performance managed against a carbon footprint, your waist generation, their performance managed against financial savings. Now we know that most sustainable solutions are almost always cheaper. However, you need to articulate this, properly quantify it, put a price tag against it or, you know less resource is required. It's etcetera, and then you will find that there will be very much on your side away really go out of their way to help you make it happen. On the other thing is to make noise eatin a cious. But since here, so make noise in local meetings, department meetings, surgical meetings, grand round quality improvement in order to meetings, make everyone in your hospital where off this fantastic work you do. The next step is to go to national and international meetings and, of course, generate a manuscript for publication. Social media and your hospital website can be very helpful. And I would strongly recommend contacting your local press officer within your organization who could be very helpful in helping you with this work. So my next steps well, my project is just in its infancy, really. My the next state release to move all mine hand surgery out of Maine theaters into a procedure room where we walk patients down, discharged, um, directed from the procedure room. They're all in their own clothes to be no gowns or no hats, etcetera. We're gonna move too small, reusable drapes. We're going to give people operate appointment times for their operation, just like a clinic. Streamline warning Ward on admission. Theater paperwork. So rewarded mission on theater paperwork. We're also doing some work around reducing water consumption in the theater by the use of alcohol rub rather than standard surgical scrubbing between cases. And we're already doing some work on rolling out Arlene Grain set up across other commonly performed operations in hand surgery. Neck femur surgery on after plus D. So that's all to do that lien set up. I'm taking a step backwards. We're looking at the whole patient pathway for carpal tunnel syndrome on for trigger finger and other procedures to try and reduce the number of times paper people need to come to see us in the hospital. So to summarize, open your eyes to environmental and efficiency. You will see it everywhere. So when you see an efficiency, embrace it challenge it changes, make friends make noise. Make time. Thank you very much. I'd like to also thank my wingman from wrecks and hospital. Breathe um, codeine. Murray consultant had an orthopedic surgeon. Also, he was my collaborator on the green surgery Challenge on is also a passionate leader in sustainable surgery. I'm hopefully the available to answer any questions for you. Here is my twitter handle and email. If you have any specific issues, do get in contact. Thank you again for the opportunity. Great. Pleasure speaking you today. Thank you. Good bye. Thank you ever so much. Mr is us in for that. That really inspiring presentation about really how to get things off the ground? Because I know from personal experience and for a lot of other people where to get started. Who to talk to you, how to go about this is, you know, one of the big stumbling blocks in starting sustainability projects were very lucky to have been joined by Mr Dawson. Just a moment. So if anyone's got any questions, can't see anything in the chart. Just, uh, presently, if anyone's going any questions. Oh, there we are, uh, warm from add Stone Canyon finally published evidence that doesn't increase infection rates or that you're a mute. Hi. Good afternoon, everyone. Yes, there is plenty published evidence about low for no changes in infection doing procedures procedure in versus an operating theater. Um, I will try and put something in the link if I can. In the chat, Um, before the end of the session, I'll upload that there was some new guidance from the British Society of Surgery. The hand that came out, uh, just a couple of weeks ago. So they're very, very up to date on these show that probably about two thirds of hand operations can be done safely outside of theater. So this is a game changing document. There's plenty of evidence from around the world that mine hand operations don't need to be done in a theater environment, so I will. I will upload that in a moment. Brilliant. Thank you. On another question in the tract from Alan Hilly, did you get much pushback your colleagues? And how did you overcome this? Well, interesting. No, I didn't get much pushback. Some of my older colleagues were a bit reticent to take this on board, and that's still a bit of a battle there, But most of my colleagues are really infused and interested in this on, but, um, their interest in it for two reasons. Obviously, everybody is interested in reducing their carbon footprint on D sustainability, and healthcare's getting much more traction. Uh, and they want to be part of it. So that's one issue on a second issue. From a practical, pragmatic point of view. It's it's improving. Anything that improves your productivity is a surgeon. There's got to be a good thing. So it's a win win for everybody. So no, I didn't get much pushback. I have some colleagues are a little bit apprehensive. Um, on my plan with that is to invite some of those colleagues to do some green green l A list with me. So, like I said in the talk, bring people on with you. Bring them on the journey. Absolutely. Thank you so much. Um, I don't go anymore questions in the chat, but thank you very much for providing your toe handle in contact details. Um, in case it does have any more questions later on. I know you're having an incredibly busy day to thank you very much for taking the time to join us on and give us your insights on your thoughts about sustainability. Thank you very much. I? Well, it's an absolute absolute pleasure. Thanks for too late for the opportunity to speak to your new governmental. Thank you for coming. Good luck to everyone with their own projects. Like I say, Like I said in a talk, just look for those inefficiencies. Find them test thumb. I caught with a different way. And then, you know, together we'll make such a massive difference. Good luck. Thank you.