Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

we're going to introduce our next speaker again, someone who I am very excited to introduce. Um, it's Miss Katy Hearst and she's someone who I actually knew was a medical student and she was a surgical registrar, and she really inspired me in surgery. Um, so I think she's a great person to have representing trainees. So Katie is a general surgical registrar in Terms Valley Diener E. And she's got a strong interest in on the plastic breast surgery. Um, following her graduation from Cardiff University in 2013, she was appointed to the Oxford Academic Foundation program, and she later became an Oxford Academic clinical fellow. She's currently chair of the Royal College of Surgeons of Edinburgh Sustainability champions, and she has recently been elected as a trainee representative on the Royal College of Edinburgh Council. There was every intention she would join us in person today that she is heavily pregnant, and, um, I know we've got lots of fantastic obstetricians here, but I think she decided she'd prefer to have her baby at home rather than five hours away. So she's going to be joining us. Um, virtually. Please do your questions in the medal chat for us to discuss after her talk. Okay. Good morning, everybody. Thank you so much for having me here today. I'm speaking on behalf of the Royal College of Surgeons of Edinburgh about sustainable surgery, mainly as my role as the chair of the Sustainability Champions Working group for the college. So it's This is a really important topic and hence why? I think it's coming up today in the in the conference. But the NHS is the largest public sector contribute to global warming, and surgery is up to six times more intense than any other hospital department. Which is why, as a college, we're really interested in what we can do to help promote changes to support our membership. Now, if you just think about just the average operation and the carbon footprint of that is equivalent from driving from the bottom of our country from Southampton all the way up to Edinburgh and this is staggering, it's literally ridiculous. And so this is why, as a college, we really want to, as I say, help our membership and and also collaborate with other colleges to see if we can make a difference to make a change and help the N H s. So when I took over this role, I think, yeah, I was naive. I think I think that's probably the best thing to say and the IV to the extent of the problem. Things like a billion gloves are used in the NHS every year. One in eight cars on the road are related to the N H s and all the reusable equipment that we do a couple of supervisors with or anybody we literally clean out a wound. Things like that, um, quite often are made in Pakistan and made with child labor. And it's just staggering that we can be promoting healthcare, knowing all of these facts. So I think the biggest thing when we came together as a working group for the college was having a look at where the problems are. And this is probably a a very known pie chart to some of you, if you're interested in sustainability, that the main problem is actually with the supply chain. But there are lots of other bits that all contribute to the total carbon emission of the N. H. S. And I think knowing this can really help in knowing what we can do on a day to day basis to try and reduce the carbon emissions, because small things really do make a difference, and especially if we all do small things together. So this is a really important diagram that literally shows all the things that we talk about very readily, and I'm going to be leading onto this into my next slides. Coming up is the things that we can do in theatre on a day to day basis. But actually the biggest proportion of things that we can do is actually stopping people coming into hospital in the first place. And then we won't need to use all the equipment that we're using. So things like preventing the disease in the first place, empowering patients with their own education, teaching in clinics about the rights and wrongs about things. And actually, then it filters all the way up to the top of the pyramid to prevent people from actually using or needing or hospitals buying in all the equipment that they do. Another way of thinking of it is a very common six hours of sustainability. So whether you think about it in the pyramid that I've just described when you think about in the pie chart that I just also earlier talked about or whether it's the six hours there's different ways that might resonate with you, but all things that we can do to try and help. So things like rethinking whether a patient needs an operation in the clinic. Do we actually need to go even go ahead with this? Are we just doing it because the patient seems to think it might need to be done? Can we step against the status quo of what's happening in hospitals? Can we say Hang on a minute? Where is this recycling bin? I want a reusable hat, things like that just not accepting just what's there. Can we reduce the resources that we use really use as much as possible and repair and recycle? Now, the later things are actually things that the NHS is looking at to see if they can do as a globally reduce their NHS admissions and it's something on the ground floor that we can help with, but the top ones, the ones that we can do on an individual basis, just in our day to day working that will just help promote, um, the need for us all to have little changes in our in the workplace. So this when I was when I took over his chair of the group, I think this was the main drive that I thought. So I took all of this information that I just explained to you and thought about How can we help our membership to deliver this on a day to day basis without any issues? And it's really like the sky theory. If we can all have tiny little marginal gains all together, it will make a difference. Instead of being that one person in theater that goes through and said, it's one operation, it won't matter if we just do it. Just it's only it's only me. Actually, If everybody did that, we're not going to make a difference. So it is all about everybody taking a little bit of responsible responsibility and just doing a tiny bit each day, maybe a little bit more, and all of that will eventually come together to make that pie chart completely different proportions to what it currently is. So we took the whole patient journey really So coming through from when you first see them all the way through to the end of the operation. And as a college we've released guidelines which I will elicit to at the end of all of this, um, to try and encourage members to talk about these things because actually, it is promotion, Um, talking about what things can be done that people know. I mean, just a few moments ago and I was talking with the tech people about just things like not using plastic in washing machine, um, tablets or the boxes and using the cardboard ones instead and things like that, it's just creating conversation. Then you start to think about little things that you can do because, especially in the NHS, your days are so busy, it might not be at the forefront that you can switch something very easily without it being a problem. So let's take it back to the beginning, so the patient journey. So can we prevent people coming in the hospital in the first place. That will prevent the need for people driving in so reducing some of the numbers on the cars, numbers of cars coming into hospitals, it might empower patients to find a bit more about their health and lead their own health situation. Can we give some lifestyle advice to help with that? Can we do direct referrals to the right clinicians so that people are coming in the hospital several times? All these little things will really help. Can we reduce? Seeing as a lot of our issues are to do with prescriptions and reusable, can we reduce the number of prescriptions? Um, and just watch and wait and give people like a telemedicine consultation in a few days and see how they're doing. All these things can streamline down the numbers of patients coming in the hospital. I'm reaching, I think, to the converted with those in the audience that are anesthetics. But, uh, anaesthetist. But you have made a fantastic forward motion in reducing the amount of global emissions from that side of things. I mean, the use of more local and regional anesthesia. People are switching over to things like Kivar. Yeah, the Royal College of anything that I think are actually probably ahead of the game of surgeons. Which is why, um, head of the game with surgeons, which is why we're really pushing now as a college to make sure that we support a membership to make big change is exactly like Urolithasis have already done. So we're preparing for surgery. So what things can we discuss and talk about with our colleagues at the beginning of the list? So can we Can we take in our own theater hat? So one thing we're doing as a college is making a theater hats that you can buy that, have your name in Barstow or that have the Royal College of Surgeons that that you can walk and where. Just one thing that means that we're not using thousands and thousands of disposable theaters every day. Gowns. Can you make sure that you can get hold of reusable gowns? I'm very lucky in my trust that both are available, and therefore I can make that active decision on a daily basis. But this isn't the same in all trust. Some only provide one or the other, and it's about talking to your theater personnel and making sure that that option is available. Same with drapes. The amount of times I'm in theater and say Why do we have disposable drapes? And for a short operation. And these years ago, when everything went through, uh, lots of diseases that were very apparent and sterilization wasn't quite as good. There was definitely a role for, uh, disposable drapes. But in this day and age, I think if you listen to some of the properties talks as well, he's got a fantastic talks about the new sterilization processes and things like that. We don't need to be doing that anymore. We can act in a completely safe environment using things like reusable drapes and gowns and something I wasn't aware until probably a couple of years ago, really was the fact that you don't need to use soap and water every time you can use alcohol based scrub after the first wash of the day That saves on a significant amount of water. You're doing that nationally. Do we need to give every single patient catheter antibiotics? Does everything need to be sent to histology all of these things, you significant amount of resource. So can we streamline that in our day to day basis and just say, Hang on, we'll give antibiotics if we need it. We can catheterize actually, you can catheterize on table if the operation gets a bit longer than you think and and histology, what are we looking for? So quite often, Now there's certain things that I won't send the histology or won't send for M C and s because if the patient already been on antibiotics prior to the operation, What are we trying to? What? We're trying to prove what we're going to get out of those results. So it's just about using your using your knowledge and using your head a little bit before we just say yes to everything. Can we avoid single use equipment? So something that has come in on a lot of the packs in my trust, these kind of waterproof sheets underneath underneath the drape, which the drapes are fairly waterproof. So do we really need extra layers of that when the patient already has a bear? Hug her as well. Um, having a look at what you use in your theatre on a day to day basis and just trying to remove some of those things. The prefilled prep ones. Can we not just use a gauze and dip it in? Uh, that already comes on our sets and trays and it saves another piece of plastic that just goes in the bin, and you can make these active decisions as a surgeon. You can just at the beginning in the who. Just ask for what you want. I'll say I don't need this. And if everybody did this, we would be able to make a massive impact on a massive difference and thinking about waste segregation. But I'll talk about that in a moment. So during the surgery, very similar things to what I've already alluded to. But do we do we need to use skin glue? Do we need to use oxygen for everything? Um, do we need to use the plastic galley pots and the plastic kidney dishes? Can we ask for those to the metal? Um, so anything that can be reused rather than put in the bin. If there's any kind of low, low carbon alternatives, push for these and your trust and speak to your theater personnel and see if there's something that you can do. One of the biggest things that you can make a difference in, um, as in you, even as a foundation or as a call trainee is pushed, suture the skin. So firstly, it trains you. That's where you get your training and your dexterous skills about closing a wound. Also, it saves a stapler, which is a big piece of plastic equipment that's flown over from Pakistan or India or somewhere and has come over, um, as a piece of plastic that then gets thrown in the bin. And you may only use half the staples, and then you've lost your training opportunity as well. So it's a win win situation, and then I promise you, it does not take very much longer to suture a wound closed. So that's certainly one of my other bugbears and theater, so that I will push for even as a as a middle grade Reg, I'm still making sure that I close the skin, but for both learning and for the environment. So, interestingly, it's better to consolidate. The research has shown it's better to consolidate your instruments rather than so I think at one point, people mentioned don't have everything in your tray. If you're never going to use it, you can always ask for an extra piece of equipment, but actually that's not quite the case. It's much better to consolidate your instruments into fewer sets and not open lots and lots of sets. So the things you're going to be using on a day to day basis, you can slightly streamline them. If there's, like 90 pieces of equipment in a set and you only ever use 30 of them, then obviously that's a lot of autoclaving for no reason. But it's much better to have a set that has all the things that you might use. And you just open the one that is to keep opening other sets to get bits of equipment and then thinking about after surgery. So you may have quite often. I think I noticed in our trust at the moment is that the, uh, anesthetic room has a recycling bin, which is amazing, Um, but in theater there isn't one. That's just the clinical waist and the normal waste. And then you're thinking, Hang on a minute, this is this is slightly ridiculous, so make sure that you have places to recycle this. Compared to all the things I've already talked about today, this is actually a very small proportion on of the issue because it's already been made. It's already been transported. It's it will help by recycling, Certainly, but not using it in the first place is a much, much bigger, um um advantage than it is to just recycling it. So this makes a difference if you have to use it. But if you don't need it in the first place, just don't use it. Um, I think it's very difficult, more junior member of the audience. You're not going to be able to get a state to kind of do what you want specifically, but generally as a as a theater group, you can be helping help and instigate. And I know we've got lots consultants in the audience as well that will be able to instigate. This is that the Department of Health has said it takes less than half an hour to achieve the operating theater settings to the right. That's the laminar flow is working. Everything's up to scratch and you can use as an operating theater and are theaters remain unoccupied for about 40% of the day, so I agree things like emergency theaters that are used all the time you need to be left on, but you definitely don't need to leave all your elected theaters on overnight. So this is a This is something that a lot of trust are looking at and have already made a difference. But turn off all your computers or the heating or the ventilation in the air conditioning all those things, and we'll save an absolutely huge amount of emissions from the energy that's being used in theater. So all of these things that I've discussed we have put together as a college to, as I say, to try and support our membership to try and give them idea is to try and say that we're here and we're thinking and we want to help you be able to do this all on the ground floor in your day to day basis. So we've come together as a group of six of us. So the president, Professor Mike Griffin, who's just on the far left hand side and myself as chair and then we've got a range of consultants, registrars and medical, and James, our medical student who is able to kind of attack this from all levels. So we've got a consultant right through the medical students, see if we can really teach people about what they can do every day. And the targets of our group have been awareness. Like I said to you, um, and to get champions on the ground floor all over the country. So with all this information, we've released lots of documentation and support to help our membership achieve these things. And but more importantly, um, spread the word to make sure that people know what they can do and that they have are support. As a college, we've also been able to collaborate. So our biggest collaboration is that we're working with all the royal colleges in the UK to release documents together as an intercollegiate group of surgeons. We've also been working quite closely with the Royal College of Anesthetist and the Association of Anesthetist and the PSAs Center of Sustainable Healthcare, which all of the above are members of the UK hack to try and really promote. That surgery is a hot spot, and we need to step forward and stand forward and say, Well, put your hands up in the air. We need to make a change, and we need to do it now, and we need to make a united front to do that, um so we are now officially kind of have an intercollegiate working group, which is making decisions altogether, which is fantastic. There's been quite a lot of, I think, years and years ago, a lot of kind of individuality and rivalries. Not quite necessarily. It's a bit of strong work, but rivalry between colleges, about what they do and what they produce. And this we're actually realizing this is a huge thing. It's We really need to work together to make an impact, because we need to do it quickly. We can't do it in 20 years' time. So the other thing is that as a college is, we'd like to lead the way in some of this work to help our membership. We've got what got a Web page we regularly release information insurgents, news about how to promote sustainability, to appear, what things you can do. We have a a webinar series that's been running over the last year and that has run with the Royal College of anything just as well. We've had members of of their accounts still come on our webinars, and we run it between different colleges so that everybody gets their own chance to host, and that's been really very well received by the surgical, um, network. And then we've tried, uh, released a series of tweets and in time with Top 26 which has also become a bit of a publication for our membership, too. Use as a resource, which is all the things that I just talked about, actually. But why we need to do it and how we can do it. And it's a bit of a prompt to say, Hang on. If you've got this and you have a look, let's see what we can do on the ground floor. But we didn't think that was quite far enough because people need to be prompted more, especially if the conversations haven't started. So one of the things that is hopefully coming to a theater near you in the very, um, very, very soon future is are sustainable theater green checklist. Um, and that will just basically be part of the who. So in the morning, when you have your morning who huddle, do your normal, um, run through the patients, make sure that you've talked about everything and then just before everybody goes off and cause for the first patient having a chat through. Is that anything that you can do to make your theater more green for that day? Uh, we We think this will just help promote conversation and promote ideas. And if we can do that, then we can make a bigger difference. Um, on a day to day level. Sorry. Oh, sorry. I thought there was some background noise there. And we're also, um, part of the green Surgery Challenge which ran was last year now, And it was earlier this year. And what We've collaborated with that, and we're hoping to maybe run something very, uh, similar in the future with the center of sustainable Healthcare. And this allowed for people over the country to put in ideas about how they can make their operating procedure or theater more sustainable. And yeah, this was really, really well received Some fantastic ideas, came out about this, so hopefully they're not to distribute. Will be doing something similar again. We're trying to promote sustainability on all our exams, so hopefully it should be on the curriculum thing. We have spoken to, um all the relevant bodies with regards to J. C. S T and and I C p, which is that the people that build a curriculum and see if we can make sure that this is a really important part of of learning and should be part of MRCS and F R. C s. It already is part of the medical school exam. So we need to make sure this is taken forward and that everybody learns how important a green theater need is. I think finally, So we've We've talked about what we can do on a day to day level, and hopefully some of you have got some ideas about how you can take that forward in your own trust. But I think it's really important as I'm here as a representative from the Royal College of Surgeons. So please do go visit our stand as well if you're at the conference. But it's not just as a college, it's not just about helping our membership. It's about getting our own house in order as well. We needed to make sure that the college is a sustainable as we can. And first of all, you may be aware that the college also has a hotel and we've been able to do things like take water bottles out of the hotel, reduce all the single use plastic. So the cosmetics that are in the rooms, low level lighting throughout everywhere, um, reducing the amount of food that we because a lot of conferences, um, and a lot of in house catering that we do. There's so much food and it gets wasted, reducing it to more, um, what people would normally eat and not have excess. We can always bring out more things like that, make sure all the stationary signed off by reusable resources and try and make as many online meetings as possible. I think in Covina we shifted towards a lot lot of online meetings, and I think we've all agree that I think probably a mix is the best way forward because lots of online meetings can one become a bit frustrating and to not always as fruitful you. Sometimes you do need to meet in person. But mixing meetings definitely helps and prevents people from flying all over the country to come and meet for a two hour meeting in Edinburgh. So I think that's what I wanted to share with you today. Thank you very much. for listening and very happy to take some questions about this. And hopefully I've given you all some ideas about what you can take forward in your trusts. Um, to try and make your theater greener just on a day to day level and some of the things that you can choose, actually, you can make a conscious decision in your day without affecting anybody else was Oh, they're, um on. Um, yeah. Just want to see a huge thanks, Katie. Um and it's great to hear about that green surgery challenge That was one by leads last year with the glasses laproscopy initiative. Um, we've got loads of questions that have come through, and I can't go through all of them. But the question I'd like to start with which I found a problem myself, um, is from Harriet Morton, who said, um, you'll know how much trainees rotate around and how difficult it can be to get projects up and running in a short period of time. So how do you maintain momentum with a previous trust when you moved on after implementing a change? Um, that's very good. Very good question. And if ideally, one of the things. Some of the things that I've done is try to work on a Dina really wide level. So, for example, things like we've been working towards reducing what preventing stopping group and saves for pen diskectomies. And we've managed to find get the backing from each of the trust within our Diener E and the data to say that one in many 100 appendicectomy he's needed a group and save, and once you've got it in every trust and you pull it together one, the data is huge. But also you have it for the specific trust as well. So a lot of the projects can be run throughout different areas at the same time. And the one thing I have been surprised about by joining the sustainability groups and all the trust in my dictionary because I've got a passion for it now is that there are so many people interested in this. So if you've got an idea, let somebody else roll it out another trust as well, because I bet you they have had the same idea but just need a bit of help and support. And so it's not necessarily that you have to take all of your projects everywhere you go, start the conversation early. So in Oxford, um, we can run something saying Milton Keen's and in Oxford and in reading a similar time and you can make changes on a wider field within the same remit. Hope that helps. But it is difficult every time you change as trainees, we're moving around a lot and you move to a new trust and they don't have the same protocol. They don't have the availability, and if you're passionate enough, you can make the change and then you'll see that change for the six months or the year that you're there. But, yeah, it can be frustrating that you have to keep doing it every time. Thank you so much. That's a really helpful response. And I think that actually answers, um, someone else's question. Who was asking about what sort of projects trainees can be doing? I think 80 is answered that nicely and saying we should be sharing ideas with each other. And on that point, Actually, um, some of our please do check out all of the posters. Um, I know that one of the posters that has been submitted is about current attitudes towards, um, in anesthesia towards T i v A. And what we can do to reduce our environmental footprint. So it's not only the speakers who are doing work in sustainability, lots of you are as well. So let's get that conversation going today. Another question for you. Katie. This is from one of our committee members, Henry the Burka. And he said that one barrier in his trust is the infection control team. I'm sure everyone can relate to that. Do you have any experience of working with infection control teams to ensure their policies are environmentally friendly? For example, unfortunately, some trust do not allow reusable hats. Um, not not specifically, actually. Um, yeah. I mean, I've I've worked closely with infection control teams to help run courses and things like that with in the trust. But a lot of these things are done at a at a higher level than than myself being a registrar. So no, I'm afraid I can't answer that one very well. Sorry. No, that's absolutely fine. And as I say, hopefully that can prompt some discussions today. Maybe someone in the room does have that experience and so final question, um is from remote Patel. Who's our gas up past president? She said, Great, thought provoking talk. Thank you so much In anesthesia and critical care. Many trusts have moved towards single use equipment such as bronchoscopes, primarily because of the cost benefit to an already underfunded NHS. Think we can all relate? How can we manage that as individuals and locally when people have moved to reuse? Sorry. Yes, please. Going to repeat the question? Sorry. And so the question essentially is, um, lots of trusts are using single use equipment, which is worse for the environment, that better for cost. How can we manage that? I think we'll say, is it's It's old data, Really, Um, and actually, there's a lot of work being put into now and a lot of research showing that although the initial cost might be slightly more, the the actual end cost of using reusable instruments is is a lot less So there is a big push in the N. H s, um, that we need to go green. And so these things are being discussed at higher levels than just as as trainees. Um, but you can ask for usable things So there's there's so many things in your theater that are available to you of what you do on a day to day basis as a foundation doctor in a medical student of registrar, even a consultant that is available in both forms. And you can just use that and know that you've used that. Then the bigger picture of the buying power from the NHS or your trust that is, has been looked at by a lot of sustainability groups within each trust, Um, to make sure that by 2040 we are making a significant change to the amount of emissions that are coming out. So, um yeah, the conversation of cost versus benefit is already happening. Fantastic. Katie, thank you so much. And I think that's a great place to finish that talk. Remembering that it's about long term, um, long term gains, that triple bottom line of not just thinking about cost, but also how it affects the environment and our patients. So I think you'd agree it's been a great session. Lots of inspiring, um, talks and conversations to be had