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Hello, everyone and uh welcome to this breakout session on um reducing waste. My name is Ria. Um I'm an intensive care nurse usually. Um I'm currently on so as a chief sustainability offices, clinical fellow. Um, so I'm based in the chief nursing office and the Greener NHS at the moment. Er, I'm really lucky to be chairing this session today. Um, and I'm gonna hand over shortly to our first speakers, which is Caroline and Amy. I'll just do a couple of uh housekeeping. Um, um, if you could keep your cameras off when you're not presenting, that would be great. Um And then we'll have questions and in the second half, so everyone will do their presentations, then we'll have some discussion and um, we'll ask the questions that are in the chat. So please feel free to put them, put your questions in the chat for us to, to keep an eye on. Um, and I think that's everything. Um, so hopefully we will be able to continue and all the technology will work and it will be great. Um So I will hand over to the first session. Um I'll let Caroline and Amy introduce themselves. Um and they're talking about their greener hospital store room in the emergency department. Uh Off you go both. Cool. Hopefully you can see some slides. Uh Yeah, can you hear me? We're all good to go. Yeah, we can hear you. Can you hear me? Good, go. Go ahead, darling. Hi, good morning, everybody. My name is Caroline Kendrick. I am an ed consultant in the great city of Sheffield. Um my lovely colleague, Amy, who's one of our excellent clinical fellows is here with us today. Um Just a quick introduction, Sheffield a we in accident emergency. We supply the big city. We are the only um ed in the area. Um Our main, we are an adult major trauma center and our aim for this is to look at how we can reduce waste in our Ed department. Um We've done this in collaboration with er CSC and as part of the Green Team competition. And what we decided was is that we've got several projects going on, which included blood, looking at reducing blood trace clotting screens, uh trying to change our cups in the department to make them more efficient and eco er better for patients. Um But what we found is that the main problem was the source um which was the store room and nobody had reviewed items in the store room and whether we could get more sustainable options. So we went right to the beginning and tried to reanalyze everything we were using. So I'll land over to Amy who will be able to give you more details about our green project. Yes. So um just to kind of reiterate what Caroline is saying is that there's lots going on in Sheffield. So we um serve a huge population and this, I just want to add this just before we start on our actual project about these completed initiatives that we've already done. And these are things that other people can also have a look at and I'm sure and there's other people talking today that have done this as well. So we just wanted to say there's lots going on in Sheffield, happy to collaborate with people um because we really wanna kind of get everything going and kind of start something really big in South Yorkshire. But on to kind of what we're all here for, I'd like to put this one in cos we kind of all know this, but it's good to kind of focus on what's happening. So the NHS is the biggest um kind of employer and therefore the biggest emitter of greenhouse gas in the public sector. And really what we're doing today is we're gonna pass the 1.5 degree climate target. So you've got to do anything at all possible to not make that four degrees hotter. Um And that's why we're all here today. I'd just like to put this in to focus us all on what we're talking about. Um So yeah, we, there was a green team project um run by the Center for Health Healthcare Sustainability, which ran in the last part of 2023. There's lots of people here today that were involved in that, but this is our one. So as Caroline said, we noticed that um there had been many, many years of, of lack of communication between the logistics guys in the warehouse or storeroom that are not clinical and the clinical people who kind of have hands on knowledge of what we actually use in the department. And this was identified by Caroline and kind of lots and lots of enthusiasm and kind of bringing people on board was needed. Um And thinking about who needs to be involved cos we can't just step on the toes of um other people. Uh you know, we can't just rush in there as doctors and change everything cos that's going to upset people. So there was lots of planning um about who needs to be involved. And then in November of 2023 we had the great clear out of this um stum which is huge. Um And this took a long time to organize and this is something, you know, if you look at our poster is, is really important if you wanted to replicate this. Um because everyone has a store room and it's a very replicable project. But I think this is the bit that you really need to um focus on if you want to kind of have a look at what your, what's happening in your store room. Um And then we analyzed it with the health of the Center for Healthcare, sustainability, recover and CO2 equivalence modeling, which I'll go into in a minute. So I'm sure some of you might know this before, but I wasn't too sure. So when you work out carbon equivalent, you either do top down or bottom up. So if we use the example of a car top down is where you don't know how much emissions the car actually produces. But you know, if somebody else clever has worked out how much a car produces per pound of petrol and you know how much petrol you buy. So you do it that way or bottom up is, you know exactly how much your car produces per mile and you just work out the miles and watch with that. We don't know how much a cannula produces of Co2. So we obviously did the top down because we know how much cannula costs, we audit it in the great clear out day. And then the lovely people at the Center for Health Care sustainability told us the carbon factor and it's quite simple mass after you have these constants. So if you're looking to kind of do some proving of carbon equivalence, the center for sustainability of the people to ask. Um So yeah, we had 10 weeks to do this project. These were some of our outcomes. If I wouldn't have, I wouldn't be able to tell you all the stuff that we did in seven minutes. Um, but all of these stuff looked like anesthetic equipment that A&E s would use a lot of, and we do use a lot of them, but we were still able to reduce the amount that we stock and buy and waste by huge amounts. And this um again, in the 10 weeks, we were able to do 25% of the stock room, which was the anesthetic bit of the stock room. And so we're looking to do the rest of the store room when we can get all these full time doctors, logistics staff, um operations directors involved to do the rest. But it's, it's quite impressive, just the bare numbers and I will give you some bigger numbers. Now, altogether, in 25% of the store room, we were able to reduce the number of items. So these are single use plastic wrapped, made of plastic, made of metal items that were just sitting in our store room to the equivalent of 10, almost 11,000 kgs of carbon dioxide. And that makes no sense really to most people, but it's the equivalent of a car driving around three quarters of the way around the world, which is absolutely amazing. From 25% of one store room in one hostel in the NHS um projected um kind of cost saving for this. As I said, we did top down is almost 21,000 lbs, which is almost another one of me. And that means that if the whole story got sorted, it's almost 85,000 lbs, which is absolutely crazy. Um We also removed our paper leaflets, which is another thing, but I know I've only got one minute left. Um So yeah, these are some pictures you can see that as well. Another part of sustainability that isn't just carbon modeling is just um social sustainability and kind of user access to the store room. So we've really tidied up and this is a much nicer kind of user experience now for the healthcare staff that work there, what we want to do going forward again, I really want to stress that Sheffield really want to get involved and kind of learn from other people. You learn from us. We just want to talk about it because it's really important. There's lots of other kind of areas in which we're doing stuff. Um But again, it's really only me and Caroline at the moment um who also have full time other jobs at the same time to do. Um I'll just finish just now with this quote from Caroline, which I promise you is real. Um And it just shows that we need to have similar to how it works in most A&E sa very flat hierarchy where anyone from consultants screen in the bottom of the cupboard to um the support workers coming up with ideas of sustainability ideas. Um It's, it's just gonna come from everyone um because it's we, we need to stop what we're doing. Um So yeah, thanks for listening. Have I mean, I doing questions at the end, but um we in Sheffield would love, love, love to kind of get involved with other people. So, thank you for listening to me. Brilliant. Thank you so much. Both. What an excellent project and I think anyone that works in a hospital knows exactly what those stores look like and the er challenges so well done. Um Lovely. So we're gonna hand over to our next presenter, which is Michael. Um So are you ok to mark? All right. Hello, everyone. Can you hear me? Yes, and we can see slides. That's brilliant. Um I will hand over to you then and like I said before, I'll jump back on when there's a minute left. Thank you very much. Yeah. Thank you so much. Hi, everyone. Uh My name is Michael. I'm a clinical teaching fellow at the Golden Juvie uh University Hospital in Glasgow. I'll just be talking about consideration of same day cancellations, the cardiac surgery service and its implication on the environment. So just as of ground uh in the NHS England from January to March of this year, there were about 21,000 same cancellation of, of elective cases in total. And you agree with me that this has a huge impact on the environment going forward. The aim of my study was to kind of analyze the reasons for simply cancellations in the cardiac surgery service of the gold jubilee hospital. And kind of look at the impact that this has on the environment was a retrospective study uh using data from the schedule in the office. I kind of looked at c cancellations between uh September 2023 to October 2023 in the service and did uh some simple statistics using Excel. So from the study, it was revealed that 232 cases were scheduled for those for that particular period under review. Out of those uh numbers, 83% of those uh sold were performed. That's about 194 cases. However, 16% of those cases were canceled on the same day, about 38 of them, all of the cases that were counseled, 86% were elective cases, whereas 13% of these cases were urgent cases. This is just a kind of breakdown of the various uh procedures. So from what you can see, coronary artery bypass graft surgeries uh took the larger percentage of the numbers. Uh 55% followed by valve surgeries, 31% and all procedures kind of uh like permanent pacemaker, insertion and 10 wound exploration uh to the other percent. The reasons for the cancellations were majorly uh uh priority cases. So uh emergency cases are coming up in theater uh leading to the cancellation of cases that were scheduled and out of these priority cases, about four of them were actually cardiac transplant. All reasons include lack of staff, uh limited oral time and patients uh been unfit uh for the procedure. Now coming to the meat of the matter. What is the impact on the environment? We talked about the cancellations. How do these uh cancellations impact on the environment and what's the uh impact on sustainability? So, decreasing overrun by 20% and a 50% drop in cancellations could result in saving uh 870 kg CO2 equivalent. And this is same as 2508 8 miles in the typical automobile just for context. This distance is more or less like a dis uh the distance from Egypt to United Kingdom is about 2600. So that gives you context of uh the, the, the carbon downside emission that will be saved by red, reducing these constation by 50%. So just to conclude, uh based on the findings, we can see that we're using this cancellation rates can actually improve, improve environment and uh implementing measures just to mitigate cancellations like in uh providing more uh operation areas, uh improving efficiency in in admin and also uh kind of uh optimizing patients prior to surgery can help us go a long way uh in reducing carbon footprint. These are my references. Thank you very much. I knew I was not gonna take up the seven minutes and I hope uh the talk has been impact. Thank you very much. Thank you so much, Michael. No, you didn't take up the seven minutes. Um But I'm sure we'll, I think of some questions for you at the end. So uh we'll, we can grill you then. Lovely. So we've got our next speaker. Um Sorry, my uh internet is slow. It's just loading. Uh We've got Lucy and Emma presenting next. Um And they're talking about preoperative hand therapy appointments. Ah There you are. Um So I'll do the same format when you're ready. If you share your blogs, we'll see that. Yes, perfect. And uh I'll turn my camera back on when you've got a minute left. All right. OK. Lovely. Thank you. OK. Hello. Thank you for having us. Um My name is Emma and this is Lucy and we have the hand therapy team leads at Northampton General Hospital hand therapy Department. Um This project that we undertook was part of the Green Team competition which we won um and was in collaboration with the Center for Sustainable Health Care. So, um a little bit about the present uh the presentation and the project itself. Um We work really quite closely with the plastic surgeons here at the Northampton General. Um And this is kind of the pathway in which um patients kind of go through in order to access hand therapy via plastic. So the patients would present to A&E um A&E then kind of manage the acute injury dress the injury and then potentially would refer to plastics trauma clinic, which is normally the next kind of working day. Um, patients attend the trauma clinic and then the registrars assess them and would list them for surgery. Um And then obviously the the patient would then go home and then come back as an outpatient for their their surgery normally a day case. Um And after the surgery is completed, the consultants and or registrar would refer them um to hand therapy via ice or online referral system. And then in hand therapy, we would receive the referrals. We kind of tend to log on once a day and we have some time allocated to triage these referrals and we would then look through our clinical diaries and allocate appointments for these patients. Um And we would pass on the, the referral to the admin team and ask the admin team to call these patients to, to book an appointment. Most postoperative patients in plastics need seeing um 3 to 5 days after the surgery, um not working days but days. So this is quite a quick turnaround to find them on appointment in hand therapy, make contact and get them seen in hand therapy. Um So, uh with that process, there were quite a lot of challenges that we encountered. Um So a lot of the patients didn't understand that they would be contacted so quickly after their surgery and be coming in for a hand therapy appointment. So we had lots of patients that would be like I thought I was seeing the consultant in six weeks and I didn't know anything about coming to hand therapy, um, which is obviously, you know, it makes people feel highly anxious and um, they're not really kind of trusting of, of what we're saying. So they're a little bit reluctant to come in for their appointments sometimes. Um, because uh we needed to see the patients. Um with such a quick turnaround, it was really difficult to find space in the diary to allocate these patients appointments within the timescale that was required. It was also really difficult to make contact with this patient group. So they probably on the day or the day after they'd had surgery, we're ringing them to try and get them an appointment in as quickly as possible, but they're perhaps still drowsy, not quite ready to answer the telephone or make appointments. Um which meant that we were then left with a high level of waste appointments. So we would hold appointments in the diary hoping that we would get in contact with people in time. Um But often we didn't, so those appointments went to waste. Um And there's a significant amount of POSTOP complications um if we delay the first appointment. Um So we're looking at there might be a lot of um edema swelling. Um There might be infections that patients aren't aware of. Um And we found that patients um weren't particularly well educated on the surgery that had been done or what to expect from their hand therapy appointment. So really, as part of this project, we looked at how we could make this more efficient for the patient, for us as hand therapy and more sustainable. So we looked at the process and we made some changes. Obviously, the initial few steps would stay the same that the patient would attend A&E A&E would treat and assess their acute injury and refer to plastics trauma clinic. Um And the patients would then still come to the trauma clinic the next kind of working day. Um, the registrars would still assess those patients and then list them for surgery. However, then we um changed the process. So we then asked that the registrars would send these patients down to hand therapy after they had finished with them in their clinic. Um The, the patient would then not, they wouldn't have an appointment in hand therapy, but they would arrive in the department. Um, we would be made aware of them and we would see these patients, we would just talk through quickly, you know, a few minutes just to give them a little bit of education on what to expect of the surgery and kind of a little bit about what to expect after surgery. So the times scale that they would be seen how frequently, roughly, um, potentially what type of splint or POSTOP, um, plaster of Paris that they would be in and kind of the general aftercare that they'd expect to receive. Um, and really importantly, we'd, we'd book them an appointment there and then, and we would always just say to them, depending, you know, if they change their surgical plan during surgery and we need to rearrange the appointment, we will be in contact with you. But otherwise assume that the appointment that we're allocating will stand. So the patient left hospital knowing when their hand therapy appointment was. Um And then, uh we'd also ask them to complete a quick dash which is a outcome measure that we use in hand therapy. Um And it just looks at the impact of their injury, pre and post therapy. Um And then the patient would leave the hospital, they'd go to go home and they'd come back um, as an outpatient again for the surgery, the consultants would then still do the formal ice referral so that we knew exactly what surgery was undertaken and they'd send us an operation note so that if anything changed any details, we were made aware and then, um we would, we were, when we were triaging, we already knew that they had an appointment. So we didn't need to allocate them anything further. Um So we measured the change. Um By looking at the total number of appointments with um within the consultants within hand therapy um with the nurse in the dressings clinic. Um the duration of time that the patients were under hand therapy, um the amount of DNA S that we had um during the time the breach to target dates for the hand therapy service, the amount that we spent on dressings and patient experience. So um some environmental um element that we looked at, we used the emission factor of 22 kg of CO2 per outpatient appointment. And that was kind of that includes travel and equipment and during the outpatient appointment. And then to estimate the reduction in dressings, we use emission factor for medical equipment of 0.46 kgs of CO2 emission. And then um our CO2 reduction was translated to a miles driven um factor of 0.3386 kg of CO2 which is the average kind of car. Um We looked at economic sustainability. So we had a look at the cost of a consultant led appointment um measured against the national schedule. Um We also um had a look at what an ot and physio appointment would cost and we have a um a varying amount of band sixes and sevens. So we took that as a 5050 average um to work out what a half hour appointment should cost. Um A DNA was assumed to be the same as an appointment. And uh the costs for the dressings were taken from the um departmental ordering and notes audit. And then from social sustainability, we um took a family and friends feedback from patients and we also got subjective feedback from staff involved in the project. Uh We took a patient sample. So one month pre doing the process change and then one month of doing the process change. Um So when we compared the two, we saved 45 hand therapy appointments, which was a reduction of 43.6%. Um, other outpatient appointments which included dressings, clinic consultant appointments um were reduced by 33 which was a reduction of 54.5%. Um We reduced the DNA rate down to 11%. I think it was about 20% before um we reduced the there was a 33% reduction in the breach to target date. Um And then the total amount of time that the patients were under our care reduced from about 78 days down to about 61 days. So about a 21% reduction. Um we looked into dressings and saved about 26 lbs, 45 and it was a 43% decrease in stock costs. And so I'm just going to have to interrupt you a bit because we're going up to 10 minutes and I don't want to miss out on anybody else's time. We just quickly this just shows us the impact that that has on the environment. I see we eat. Yeah, that's fine, bril. Thank you. Sorry to cut you off. Um But we'll, we should have some time at the end for some questions and uh we can definitely look at your outcomes a little bit more then. Thank you. Thank you both. So, uh we're gonna go on to uh Catherine now. Uh they are lovely and if you get slides up, perfect. Um So, yeah, I'll let you carry on. Excellent. Uh Thanks and so, so nice to hear the previous presentations too. Now, my name is um K Boron and I'm a, a research associate at Barts Health NHS Trust and I have a background in physiotherapy. I'm presenting on behalf of my team. You can see their names here, mostly um physiotherapists and uh specialist nurse. And I'll be telling you about the environmental impact of specialist physiotherapy for limb reconstruction and in particular, the unexpected um findings around removing circular frames in um in clinics. Um So just to give you a little bit of context of what um limb reconstruction entails. This is what the limb of a limb reconstruction patient normally uh looks like. Um So they um they, they have these circular frames put on to manage often, very complex, often open and fragmented fractures uh which impact the skin vascular system nervous system and the there can be infections in as well. So the circular frame really is an alternative to the traditional plates and screws because A that wouldn't be suitable, too many fragments um or unsuitable tissue and B it might need adjustment over time. So especially if they are bone gaps, the pins that you can see can be uh moved to encourage bone growth and correct deformities. So it's a process that really involves a lot of time, resources and expertise. Um I've told you a little bit of what it looks like from the surgical perspective. But actually, memo reconstruction involves a lot of other specialties and factors from wound care and aftercare, uh rehabilitation and uh then finally discharge and frame removal. And it really takes an interdisciplinary team to do this. But because the surgical aspect is so prominent and so important for these patients, sometimes things like rehabilitation can take the backseat and um uh and patients don't get the rehabilitation they need when they need it. So this is why um we introduced a specialist physiotherapist within the limb reconstruction service. And we wanted to see what the environmental impact um would be as well as um a as well as the um physical and social outcomes that we expected. So um as part of the Center for Sustainable Health Care uh Green teams competition, we used a SAS Q I model for this project um which uh ultimately means that we were looking at environmental financial and social and patient outcomes at the same time. We um looked at data from 60 patients, more or less uh a few from the standard pathway. So when we didn't have a specialist physiotherapist and a few from afterwards, um when we did have um uh physio and we extracted a whole bunch of data just to explore um what, what would pop up. So type of injury, date, removal, frame, removal, location, patient outcomes, often subjective quality of clinical satisfaction outcomes, etcetera, as well as a bunch of resources. Um And the first things we noticed were that from the point of view of appointments, there wasn't much change in terms of imaging, there wasn't much change, you might say, oh no, actually there is perhaps a little bit of a difference average wise, but statistically on such a small sample, when patients are so widely different from one another, we didn't feel um it hit home, obviously, from functional outcomes. We were seeing um positives, but we didn't feel our data was robust enough. What did pop up was um that in the physio pathway, the frame removal location started changing. So rather than um than patients having their frames removed in theater, they were having um their frames removed in clinics or the majority of them were. Um So we looked a little bit more in depth into this um I into the resource um uh usage of the uh two different pathways of removing frames in theater versus in clinic. Um So you can see a few uh initial differences here, differences in anesthetics, differences in stuff in um consumables and um obviously estates and energy um to calculate uh the carbon estimates associated with these, we used a mix of both bottom down and top up carbon costing measurements, obviously, with the help of uh center sustainable healthcare, which were really um who were really helpful. Um So these are our results in terms of environmental sustainability and we calculated we expanded the results to forecast for a whole year. So based on a caseload of 100 and 20 patients, and we noticed that via clinic removals or increasing the number of clinic removals, we had a 19.7% reduction in um in carbon uh emissions, which uh I will also tell you how much that uh equates to in terms of driving a car, it's about 12,000 miles, which is uh a return trip to Argentina if you could drive there from the UK um from a um AAA little addendum to the sustainability. Uh But you might notice here that in terms of um uh um anesthetics, we were still consuming quite a lot in clinic. So we did forecast what it would look like if we switched um if we switched anesthetics. Um So there are savings and further projects that we're going to do. Um from an economic sustainability perspective, we saved about uh 54,000 lbs a year and this is after having paid for an extra member of staff. So for the physiotherapist, which maybe tells us a little bit about how little we get paid. Um uh and just uh uh I've told you about uh the impact on um on uh patient and functional outcomes. People were getting better sooner, but we would want um longer, a longer duration of data um uh to, to establish that we have since been disseminating our work with, with the orthopedic department to try and sensitize colleagues to um uh sustain more sustainable orthopedic practices and uh applying this to other areas of um um of orthopedics. Um We do think it makes a case for the value of allied health professionals and especially physiotherapists who are normally seen as purely rehabilitation specialists, but actually as part of an MDT, they can take up different roles and they can, for example, help people remove frames in clinics which has positive outcomes for everyone. Um So yeah, I'll uh finish here since I'm probably running out of time. Uh But any questions later on. Thank you. Thank you so much. What a brilliant presentation and so thorough with the numbers and the data. Um Lovely. So we will move on then to um Patricia who's gonna uh talk about bowel prep for colonoscopies. And um yeah, and just keep thinking of your questions and feel free to pop them in the chat at any point. Um And we can ask them uh when we get to the end. We should have some time. Uh Patricia, whenever you're ready, we can see your presentation. I just can't see you yet. Oh, bro, there you are. Thank you. Lovely. I'll, I'll jump back on when you've got a minute left. All right. All right. Thank you so much. So, my name is Patricia Ojo. I work in, I'm a staff nurse working in Endoscopy Unit, Northampton General Hospital and we looked at Bauer preparation for colonoscopy as a project with the in collaboration with the Center for sustainable health care. Um from the later part of last year from October and was presented um early this year, Northampton General Hospital, which is a very um endoscopy unit is a very busy um has a very busy endoscopy unit with three rooms offering diagnostic therapeutic and surveillance on, you know, bower screening and we service patients, you know, around Northamptonshire and the neighboring Northampton and neighboring co uh counties. We see a lot of patient, for example, in October 2023 alone, we saw nearly 1000 patients, 397 of which were for colonoscopies. Now, we know that for colons colonoscopy to be, you know, to be effective, to be qualitative and to have the impact that we needed to have, which is for the inner lining of the colon to be properly seen and assessed the patient has to take bowel preparation. And the bowel preparation itself is usually uh challenging for patients. Also from the available data, we know that inadequate or and incomplete bowel preparations can lower screening effectiveness and increase healthcare expenses due to longer or aborted procedures. Endoscopy is a resource intensive. Endoscopy is resource intensive and a major contributor to the environmental footprint of health care. And the third highest waste producing department in the NHS, the fourth highest uh highest uh waste producing department is the theater. The next one is anesthetics and the third is endoscopy. So, in looking at this um project, we aim to prevent repeat procedures. We aim to reduce financial waste and um improve preparation for our patients who are coming for a colonoscopy. In doing this, we looked at our processes from referral to the end, you know, or to the end of the procedure from when the patient was referred to ros how we, we, we book the patient in all the resources we use um when the patient comes in for the um uh to collect their bowel preparation or the paperwork that we need to post to the patient when the patients are ready, you know, to come in for their um attending for their um appointment. And um if the bowel preparation is not great, it all means that, you know, this patient will have to come back again, you know, repeating the pro the process again and again, this, you know, um exact pressure on the system because we now because of the um I information that is widely available for patients. Now people are you know, coming to have their um colon checked, they are coming to have, you know, uh for screening procedures for diagnostic procedures. So we aimed uh to get it right for a patient at the first time and to review uh to reduce unnecessary waste. So we uh calculated the carbon footprint, uh colonoscopy obviously in in collaboration with the Center for Sustainable Health Care. And you know, we looked at all the consumables, the reusable and the medical equipment that we we need to use, you know, for success, um successful colonoscopy and the um patient travels that is involved. Everything you know, came to 17.5 kilogram which is equivalent to driving 51.7 miles in a car, as we said earlier on bowel preparation is challenging and it is often described by patients as worse than the procedure itself. So our department um routinely used movie prep, you know, uh we, we, we certainly give our patient mo to pre to prepare their uh bowel excuse me, which is quite challenging for patients, especially um you know, elderly patients, people who already have, you know, um various comorbidities. It's quite challenging for them to take Moviprep because Moviprep involves taking 2 L of um the bowel, the laxative, the strong laxative itself and 2 L of additional um amount of water. So the patient, you know, coming for colonoscopy, if we give them moviprep, which we historically, you know, dispense to our patients. They have to take 4 L of fluid. This is in, you know, in combination with the amount that, you know, they have, you know, fasted, they, they are already, you know, anxious, you know, patient coming from, you know, um colonoscopy, they are already anxious because so I don't know what is going to be, how, what the result is going to be. It's already, it's already a challenging time, you know, for the patient coming for this procedure. So we while looking at this, you know, the the whole project, we decided as a team to switch to Plainview, which is a low volume um uh bowel preparation and it's easier on the patient that the compliance is better for our patients. So we looked at the the the the the aim, you know, to improve our preparation, precolonoscopy. And then the outcome for us, you know, as a department is that we switched from routine use of movie prep to Plainview. Plainview is cheaper is um is easier on the, you know, for the patient to take because a low volume is only 1 L for them to take compared to um the previous 4 L that he had to take. And we look at the clinical impact, you know, it's a significant reduction on um in the volume that patient needs to take the elderly patients. Are they are they are um they are more compliant, you know, with it and then environmental impact because as I said, one 17.5 kg of CO2. So we looked at that projected over one year and we will save um 4000 and 27 miles, you know, in an average car, we have uh completely um made a switch, we have completely made a switch to plenty which, you know, um our patients are more compliant with. We have staff survey and you know, staff are happier patient coming in for the procedure. They are, they are um taking the B pre as needed. And um, we've made significant financial saving. As I said, plenty is cheaper and per year, we will save 29,284 lbs, you know, to the, from the switch alone and from other um financial income per year, um for the hospital will be 72,226 which will replace, you know, failed procedure wasted appointment from, you know, cancellation and DNA because if patients are not, if they haven't taken their bowel prep correctly, the procedure will fail and they have to come back and then your social impact, the staff are happier. Um They, they believe that the switch will, will improve the rates of um uh patients compliance. My final um slide, the study supports the use of plenty as an efficacious bowel preparation agent. It's a low volume bowel preparation agent and it's cost effective and it's an um attractive alternative for patients for the the the the full um project paper has been uploaded up um uploaded to the Center for sustainable health care website. So uh for interested people, you can, you know, go run there and see the full paper, you see all the datas and um and your references. Thank you. Thank you so much Patricia. That was really interesting. And um yeah, what great numbers again. Um So I'm gonna hand over now to uh Joanna and she is hopefully, I will share, hopefully you can see me and hear me now. Yeah, perfect. Um So my name is Joe Morris and I'm a resilient officer at from Town Council and with me in the room is Charlotte Carson, presenting from her from her screen. Uh And Charlotte works at from medical practice and today we really wanted to talk to you about uh the project we deliver uh in from a small market town in Somerset. Uh Green Healthy, sorry, healthy health project is an energy advice project that we deliver with the medical practice. Uh And it's part of a much much larger program called Green Healthy Firm, which is a unique partnership of a social enterprise adventure firm from medical Practice and from Town Council and uh is funded by the National Lottery Climate Action Fund. The Green and Healthy Project explores ways we can help our residents improve their health. And at the same time, reduce the carbon footprint uh emissions. Uh And because we believe health and climate um are very strongly interlinked. Uh For example, we explore uh ways we can help help residents uh improve their health. Like for example, um talking about active travel using reusable period products and um looking at type of medication they use. So for example, the medical practice have been encouraging patients to switch from um uh inhalers. Um what are the inhalers called charlotte, the standards um spray inhalers to turbo inhalers because they inhalers because the carbon uh emissions link to those are much, much lower. So it's just an example and it's a really, really wide project but healthy home strand of green healthy form uh is an energy efficiency project. Um And it was created to ensure that our residents at that co at risk of living in the cold homes get support they need. Um About third of uh our majority of our missions, sorry. Majority of our mes in from come from uh heating our homes and we've got very traditional drafty, old traditional housing stock in from predominantly uh and we find a lot of people that live in the drafty dump and insulated, difficult to heat homes. Um And in this particular strand, healthy homes, we deliver in partnership with from medical practice uh who help uh us uh get to patients that need more support. And we also as a delivery partner, uh we work with the Center for Sustainable Energy who uh are charity based in Bristol. Uh not too far from us who specialize in um delivering energy advice and um linking people to funding, uh providing support with uh energy related debts and things like that. I will talk a little bit more about where my clicking showed. I've got too many keyboards here. Uh Here we go. Thank you er about physical impacts of living in the cold home. Um And we know that temperature temperatures when they reach um drop below 16 degrees um can cause a lot of problems for people. Uh The more they drop, the more problems we see with um constricting blood vessels, um increasing um BP, uh thickening of the blood because of the temperature can cause uh clotting if those clots uh form in heart or brain or travel there, they can cause um heart attacks and strokes. Uh also cold, cold temperatures, we see a lot more uh falls and uh people hurting themselves in their home because they, they've fallen over uh and then also um cold damp homes and humidity, uh over 60 degrees uh breeding ground for or spreading grounds for sports, um which can then uh affect um airways, respiratory issues that we see as a result of that and skin problems and eye problems in some severe cases, even death. I don't know if people remember um the little boy in London, uh it was a couple of years ago. Uh a two year old boy died as an effect of being exposed to uh some really higher levels of uh of mold in his uh in his rented accommodation. Um and it's expensive for NHS. Um cold drafty, insufficiently heated homes are very expensive to NHS. Uh They cost more than 2.5 billion a year and this equates for nearly 7 million a day and excess winter deaths stood at over 15,000 people um dying um between 2021 and 2022. Uh with 21.5% of those figures attributable to uh living in the cold conditions and many of them could have been avoided. So what's been happening to healthy homes? So due to our partnership with the medical practice, um the medical practice uh have been sending letters and texts to patients. Um just in the first year of our delivery um phase, we are now just in the beginning of the second phase. Uh In the first year they've delivered um over 1300 letters and text signposting them to us to, to what we at from Town Council and the Center for sustainable Energy can offer and what we can offer is energy advice uh dropping sessions, they are normally held at the library uh or in uh different places in town uh community centers at the town hall. During lockdown, we had um phone visits that people could schedule and as a result, uh we often deliver home visits and we have funding from, from renewable and Energy Cooperative uh to also install, install draft proofing in people's homes. Uh You can see me on the picture there installing um uh insulation for, for someone's hot water tank that's gonna save us, save them a lot of money. Uh We offer energy saving kits that people can hire to learn more about the energy they use at home and for those people that are waiting for support, um uh we offer winter warmth packs which help them stay warmer at home. Uh And hopefully we can help people during home visits or energy advised sessions. But if we can see the case is more complex. So for example, someone is eligible for funding for installation, then we then refer them to our partners, the Center for Sustainable Energy and sometimes they also struggle with energy date that debt and we can uh assign them um a caseworker as well for the Center for sustainable Energy. Uh We also uh the uh offer retrofit assessments um For those who don't know what retrofit means, it refers to any improvement work to an existing buil building to improve its energy efficiency and making it easier to heat, able to retain that uh for the heat for longer and replacing fossil fuels with more renewable energy and more sustainable choices. We've got a dedicated community retrofit lead again, funded through um climate action fund and the lottery. And Sally is able to deliver free, um, retrofit assessment to every home, uh, which I normally uh about 8 to 8 900 lbs. It's a really detailed report over 70 pages um that, um helps people uh, improve their home and uh comfort in the home if they install the measures. And, um, after the retrofit assessment is done, we offer um, phone energy advice as well to help people through the process. Uh And again, it's a really impactful uh service. There is an estimated 42 P saving to the NHS for every 1 lb spent on the retrofit uh of fuel poor homes that we have in from uh following the report really quickly. I know I've got a minute left. Uh some um figures and some impact uh from the first year, uh which we just finished um delivering, uh we are only a small market town in from, but for healthy homes, we were able to help um uh 1660 64 from residents with advice, financial support and referrals for referrals for energy efficiency measures. And 48% of these people are the most vulnerable residents uh often um in receipt of benefits so far, the support adds up to more than 41,000 energy cost savings and 21 tons in carbon emissions, which um is equivalent of taking 11 average size cars of the UK roads, uh and S so far, um, delivered, um, retrofit assessments to 32 households totaling um, of 85 residents. Hopefully these people can improve um, the comfort and health uh in their home, uh, further and just to finish off in case anyone is local or knows anyone in Somerset, these are contacts for us, uh, or how to get support and then hopefully we can answer any further questions uh during the end of a break on session. Thank you very much. Thank you. Um I can't believe we've gone from Bowel prep to retrofit in homes with things like it's such a broad range of um, of projects that we've just seen and I think we need to add up all of the miles that have been saved driven in the average petrol car, which is our measure, isn't it? Um So if uh anyone has any questions, please put them in the chat. I did see that we had one from, um, from Jackie and Emma and L for Emma and Lucy, but I think they've had to go. So if you were a speaker and you'd like to put your camera back on, um, maybe we can have a little bit of discussion and we can see if there's any questions in the chat or if anybody who spoke. I know we can't have people in the, who are watching, um, speak, but you can put them in the chat. We're keeping an eye on that. But if any of the other presenters wanna um ask any of the other presenters, any questions, please feel free? Oh, Amy, I thought you were talking about. Oh, sorry, I'll just, I'll just sorry, I've had my microphone m um I'll just, I'll just take like the embarrassment of speaking first, which is always an issue on these kind of calls. Um It's, it's, it's really interesting to like, could you kind of just what I said in the chat, how um we kind of are doing all of this in the kind of scheme of green sustainability. But actually, and I think there's a mindset switch that we've been going on along with this status quo for so long and all of these projects is like, it's fine to have all of these frames taken off in theater. And actually, when you step back and look, it seems obvious, doesn't it that we should be doing better in all of these areas? So I had to go and let a gas engineer in. So I missed a couple of the projects. But, and all of us, even though mine was a storeroom, cardiac theaters, town councils, we're all kind of doing the things, which is just really nice. I just want to start off the discussion of um all of these projects I think could be done at Sheffield and I'm sure they could all be done at Phone Council and it's just really interesting to share these ideas. So Yeah. And if you have any specific questions about how you want to organize your storeroom because we all have storerooms that have probably got out of control. Happy to take them. Um Similarly from people that can't have their video on in chat. That's cool. And thank you, Bril. Thank you, Amy. I do have a question about your store room and one of them was um how did you find the time to do it in EDI? Think that's a real um usually so EDS particularly there. So you, you say that, but we have lots of people. Um and specifically my job, I actually get paid not specifically to do this particular project, but I'm a clinical fellow and any other clinical fellows around, you know, that you have time allocated to do certain projects. Um So getting clinical fellows and like, you know, getting the higher ups to hire clinical fellows that aren't patient facing all the time, kind of like your job, Bria um is useful and I'd say that's one thing to get um kind of Carolina is the er uh training lead training program director for the whole of South Yorkshire as well. So it's incredibly difficult and that's why we only managed to do 25% of one store room in 10 weeks. Um So there is no easy way. That was the one day that we could do it. And that's to get the guys that work in the store room together clinical leads that can actually make decisions about reducing certain stocks to ensure patient safety is maintained, the operations directors that actually write the checks all in the same room at the same time. So there's no, that is how you just have to drum up enthusiasm, I think and get people interested. And I'm sure you've all found that actually once people are on board with you, they're happy to give up time because we all came in on a day off basically. Um I think probably I was the only person that was possibly paid on one of my project days to do it. But um and I think this is a real issue and something where people, you know, sustainability fellows, sustainability leads for trusts, you know, it's coming, but funding for specific people to do it is needed. I'd say I couldn't agree more. Absolutely. I'm sure everyone um who's done these projects um would agree. You've probably had to do it either in your own time or squeeze it into your clinical time. Everyone's nodding. Everyone wants to comment, feel free. Yeah, I suppose with the letters that we sent out with healthy homes, we had very aware of people's time. We had to integrate it into a system, a process that was already happening because there was so much pushback. So it's trying, I am paid to do this. So maybe so that doesn't really fit with what we're saying. But in terms of the other people who were putting these processes out, it really had to fit with what was going on, which is what we say everywhere with Sas Q I projects all the time is how to integrate this, how to align it with what's already happening. Yeah, I can't believe there were so many people on their day off doing that. It's just so frustrating. Maybe more than one person was not on a day off, but most of them were doing it through, they wanted to do it, which is the main. So Caroline, I'd love to get all of the cost savings that even just these examples get all those cost savings. And at some point, we're going to have to reach net zero and we're going to have to look at carbon credits and in reality, we won't be able to reach a point where we're completely um no zero within our own organizations. And can that investment instead of going to plant trees somewhere? Just bring that back into these projects? That's, yeah, absolutely. Catherine, go ahead. I totally agree with Amy and everyone about the value of hearing about everyone else's projects and seeing how much energy there is to, to improve. I guess I'm, I'm looking at the comment that Emma who's left from the um hand therapy team uh said, and she was unable to disseminate her um her qi project with the National Association for Hand Therapists because of uh uh a qi project lacking uh ethics approval. Um And, and I guess what, what it's telling me is the difficulty of um of scaling these projects because obviously we're all talking about our individual trusts or our individual areas. Um And uh I just fear that we don't really have time for everyone to be reinventing the wheel all the time. And although it is more fun, I guess to uh uh reinvent the wheel, then uh then to have to implement somebody else's project. Um I feel that we, one of the big issues is that we lack the space to share these kinds of projects and it's great to be um on uh on conferences like these, but I do feel we're preaching to the converted. Um And uh and I don't know if anyone has any ideas or um things that they've done in their own area of practice to try and disseminate and have a larger that would be great. Um So something that kind of comes to mind and obviously we're an A&E department, but our Royal College is really, really into this. I'll just put the thing into the chat. So the Royal College of Emergency Medicine has talking about ethics committees and stuff piloted and ensured safety in a lot of kind of areas that a A&E focused but lots of them, everyone can do things like um pa going paper free, reducing cutlery, responding to staff and patients suggestions. It I think, um, you know, there's been nothing that I've seen anywhere. It hasn't been advertised very well from NHS England to standardize something that everyone can do together. And I don't know if I'm wrong about that but, um, am has the Royal convert medicine and I'll just put it in the chat. There's lots of resources um from them. Um, and they're not all A&E specific, um, but they could be like, you know, and they have been tested, there's like lots of green pa um white papers that they've brought out that it does not affect patient safety and they can give accreditation like bronze, silver and gold. Um So that just as an actual physical thing um it's in the, it's in the chat. Green ed.com dot ac.uk. Thank you. I may uh Patricia's got a question for Michael. Do you wanna ask it on the out loud Patricia? Oh, hello. I was just wondering Michael, the the data that you? Hello? Can you hear me? Yeah, I can hear you. Yeah, the data that you looked at um are they simply those cancellations? Are they simply for clinical reasons that is, you know, clinicians canceling the patient on the day or are they uh DNA S that is, you know, the patient have been booked for their procedures and they just didn't turn up? Ok. Thank you for the question. So I actually classified the reasons for the c uh cancellations into various categories and for all the patients, regardless of the reasons. These are not patients with internal. So there are actually patients who came in the previous day, uh, admitted for their procedure and the procedure was canceled on the day of the procedure. And clinical reason was, well, I mean, one of the reasons, but it was not really uh, top there, most of the cancellations were due to uh, limited or space uh, emergency procedures coming up and, uh, other reasons but for, uh, cancellations based on patients being on feet, I think it was just about, uh, uh, 7% thereabouts of such cases. Yeah. Yeah, I just, I just wondered because when I was, you know, during, um, uh, about pre, uh, project as well, we looked at cancellations by patient, you know, cancellation due to clinical reasons. For example, some patients who didn't say stop their, you know, anticoagulants, medications, um, some who couldn't even, they, they were so anxious, they couldn't even take the bowel preparations. We look, looked at those and those that were canceled on the day for people who they took the bow bowel prep, but it wasn't effective. So I just, I just wondered if you and how we, how we address the DNA S, you know, on the patient's side. That is the people who didn't, um, I mean, the ones that we canceled on the day due to number one, probably not taking the, the, um, anticoagulant, how we address that because we have addressed that is now we have now set up a preoperative assessment that is everyone booked to have colonoscopy. Now we we we have a designated nurse who called calls everyone, you know, prior to their um appointment. So I just thought that, you know, if you have DNA S um based on, you know, reasons as such, maybe you have a service, you know, that will, you know, address that, you know, call patient before the appointment just to address some of the issues. Thank you. Ok, thank you. Um Megan is cro sharing the session with me. Um I'm gonna put you on the spot, Megan and uh see if you've got any questions for anyone and if you want to introduce yourself and what your, what your role is at the moment. Well, you're on mute. Sorry. Can you hear me now? Brilliant. Hello, everyone. I was just saying how I really enjoyed all of your presentations. I'm currently a student at Brighton University, studying Adult Nursing. Um I'm currently in AQ APL placement where sustainability is my project. Um So it's been really interesting delving into that and um I've become a part of the Planetary Health Report card as well for the coming up year, which so that's been really interesting as well. Um I've been joining Heather to do a bring out an article to be released to critical care units across the country as well um for environmental sustainability. So, yeah, I'm just enjoying taking it all in and learning. Um, but no, it's been great. Yeah, I love hearing all of your projects. It's been really, really, really good. Well, and, um, just to finish cos we've only got a few minutes left. Um, what do you think if we go around everybody? What do you think you'd give your one top tip to Megan as she goes into being a qualified practitioner? What one thing would you say to her for being a sustainable nurse? Feel free to jump in? Can I can I just say something? I think it's quite interesting listening to everybody because everybody is on the ground and doing the work and can make changes and changes can happen if people push and they got a desire to change. The problem is, is that without financial backing in a nice way, it's very difficult to make changes. So personally going through store rooms and, and looking at the NHS supply chain and trying to make changes and it's not the people on, excuse the term on the ground. Everybody like our department, they're, it's so amazing that everybody's on board but trying to make changes in the NHS is very, very difficult. That's what I'm finding. So my, my advice to Megan is to push and to keep trying cos sometimes it can be quite demoralizing um that, you know, you can see a simple change needs to be made and trying to make that change is so difficult. But then what happens, what we're finding is, is that we get a snowball effect. So we've made one change which has led to another change, which is leading to another change. And actually, I think it's a small changes that when you accumulate them make a big difference. So, you know, I'm not sat here saying I'm perfect by any means. But what I'm trying to say is I am trying to make a few changes in the department. And when people get on board with that, it's amazing how you get invited to conferences like this and you pick up ideas, et cetera, et cetera. So the future is investment ultimately from trusts and departments and it's trying to push to show that you can make that money back and make more sustainable changes. That's what I feel. So that would be my advice. Keep pushing. Hm Yeah, I was just going to say your top. No, go on. Yeah, I was just going to follow up, but you kind of said it at the end, Caroline that um choosing the small changes that save money uh always resonate with people whether they're environmentally orientated and focused or not. Um And then you've got that win win situation when you save money, but also save carbon, for example, always, that's what I was going. Um I was going to say um that one that was good for us was to listen to colleagues from different backgrounds because what might be the most pressing issue from a sustainability perspective for you might not be so for your colleagues and other disciplines and might actually have a ricochet effect. And I think a lot of the difficulties in implementing changes because we can't see other people's perspectives. So um just being open and curious to others is good. Yeah, and there's lots of ways of spreading enthusiasm for different people. So I think what is, and other people are saying about money being a driving force for the important people ie corporate and talking in corporate terms, which is not what doctors, nurses are used to talking. I think the competition orientated projects that have like a focus on financial gain really help us to communicate with corporate. Um, because, you know, we are used to kind of talking about Cannulas and stuff which isn't very corporate whatsoever. So, yeah, having that language is you need it because you have to play the game, you know what I mean? Um Any other, I guess just because there's time left, but I haven't worked in healthcare for that long. But at the beginning I was quite fearful of bringing sustainability into everything we do. But now it's like, have that confidence and trust that this is where we're heading and it's a responsibility to bring it to the table all the time. So having it in mind keeping it there talking about it to people rather than it just being a concern that we have hidden in the background. It's like voicing it and sharing it. Yeah, there was a study that science.org did a few years ago on a tipping point in terms of environmental change and if 25% of people start talking about something and doing something, then the rest follow us apparently. And it happens with many, many things in history. So we just need to carry on talking about it. Any um Patricia's put you a, a comment in the chat as well. Me, um any final comments from anyone before we end the session, I think it's been a really positive upbeat session. Um And yeah, really inspirational chat at the end. So thank you everyone for, for taking part. Um And thank you for your presentations as well. Um And yeah, enjoy the rest of your day. Unless anyone's got anything else I wanna add. Nice to meet you guys. Thank you. Thank you and I believe it's lunch time now. So go and get some sunshine. Thank you everyone.