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Green Surgery Report: Surgical Care Pathways

Interventions throughout the surgical care pathway can reduce environmental impact of surgical care

Read Section 3 of the Green Surgery Report

Section Highlights

The environmental impact of surgical patient care can be reduced by interventions throughout the surgical care pathway.

Streamlining patient pathways includes reducing low-value steps and unnecessary consultations (including creating ‘one-stop’ clinics), and rationalising and eliminating unnecessary pre-operative investigations.

Use of telehealth, digital patient management systems and centralised lean electronic medical records can reduce carbon impacts.

Pre-operative optimisation can reduce complication rates, including smoking cessation, alcohol moderation, exercise, nutrition, and weight optimisation.

Operations should be performed in a timely manner, and in ambulatory day-case or outpatient settings where clinically appropriate.

In-hospital stay can be minimised, for example through enhanced recovery protocols and early discharge planning and virtual wards.

Post-operative tests and imaging should not be performed where unnecessary.

Section Recommendations

(1) Streamline surgical patient pathways e.g. reducing low-value steps and unnecessary consultations; rationalising unnecessary investigations (pre-, intra-, or post-operative); creating ‘one-stop’ clinics

(2) Optimise patients pre-operatively (e.g. smoking cessation, alcohol moderation, exercise, nutrition, optimise weight)

(3) Minimise length of hospital stay

Case Studies

Carpal tunnel decompression in procedure room

Digital care pathway for total knee replacement

Early mobilisation in CICU

Eliminating unnecessary pre-operative blood test

Omitting routine Group and Save test

Reducing pathology sample transport

Reducing same day surgery cancellations

Shortened admission booklet

Virtual fracture clinic

*** Note: Outcomes data from case studies have not been verified and some financial and greenhouse gas emission figures are based on projections.