Authors: Helen Wilkins / Editor: Charlotte Davies / Codes: SLO10, SLO11 / Published: 04/07/2023
Starting from scratch to turn your emergency department green is a challenge. When I took on the sustainability lead in our department recently, it took me a few months to work out where to start and how to make things change. I thought it would be useful to share some of the things I have learned along the way.
1.Engagement is key
Getting people on board is the biggest challenge. Talk to a wide range of people who work in your Emergency Department (ED). Support will come from the unlikeliest of places! Include all staff groups, i.e. medical, nursing, portering, estates and management. Set up a GreenED WhatsApp or Twitter feed. It takes a whole department to make real change, but lots of small changes in behaviour soon add up. Engagement and direct feedback to the staff involved is the most effective way to create change.
2. Start with the easy wins
Recycling and the use of single-use plastic in catering are relatively easy to fix. It is really important to know the system well, so you will need to walk through the whole waste process; for example, how is waste segregated once it leaves the hospital? If it is separated off-site, there may be a perception that all domestic waste goes to landfill. So it is worth doing a waste walk, making sure there are enough recycling bins and that the signage on the bins is clear (no masks or gloves to go in the recycling!). What can be recycled may surprise you; for instance, in some Trusts, plastic wrappers from syringes, cannulas and intravenous fluid bags can all be recycled. Speak to your Trust waste team to find out more.
It will be hugely useful for you to know the person who orders the stock for your ED, as they can give you up-to-date figures for usage and annual spending. You will probably have to persuade them to change the catering order to bring in more sustainable items, which are probably a bit more expensive than what they are currently buying. It is worth noting that most green interventions mean using less, for example rationalising blood tests, so any increased spend on paper cups or sustainable cutlery can be offset against savings elsewhere.
3. Identify your carbon hotspots
This is a really important consideration as you decide which projects to prioritise. Once identified, how are you going to reduce these carbon emissions? In some departments, a carbon hotspot may be nitrous oxide use, which can be reduced by switching off manifolds that supply the ED or replacing metered-dose inhalers with dry powder inhalers, or recycling clean packaging rather than putting it in the clinical waste. The GreenED framework has a lot of targets that are achievable in your department.
4. Find out what the rest of the Trust is doing
Is there a sustainability or net-zero group that you can join? This is a brilliant way to link up Trust-wide projects such as glove-use reduction (RCN Video) and to find out about other projects (recent examples are the increased availability of e-bikes and the creation of an on-site nature reserve).
Are there designated sustainability leads in infection control or pharmacy, or even a net-zero lead or sustainability manager for the Trust?
Finally, is your Trust part of any initiatives such as NHS Forest? Have you received the decarbonisation grant for the use of renewable energy? You are likely to find some surprising things; for instance, our Trust has instigated a pollinator-friendly planting scheme and has installed four on-site beehives!
5. Reduction is best
Reduction of use has the greatest carbon impact, followed by reuse, then recycling (in most cases). For example, reductions in cannula use and rationalisation of blood tests on admission both have the potential to save huge amounts of carbon and money. Calculating annual cost savings for projects is a huge motivator in changing behaviour from the top down, and will make you popular with managers!
Reductions can also be applied to staff travel where appropriate, by exploring the use and the rest of the green impact of having staff physically in the hospital, so look for opportunities to promote the use of virtual meetings or virtual teaching sessions. These may also be good for staff well-being.
6. Saving money and good publicity are great motivators
Calculate your annual spend and how much you could save. Aiming for GreenED accreditation status by following the points on the framework is a good way to gain support from your Trust. Could you be the first ED in the region to achieve a certain goal, such as removing nitrous oxide?
Use your Trust communications team to help to promote all the green work your team is doing. Learn how to carbon count so that you can measure the impact of any changes made (this course run by the Centre for Sustainable Healthcare is good).
7. Working out how to persuade an already exhausted workforce to make changes is a challenge
Saving the planet may be the last thing that staff are thinking about when there’s a long wait in the ED and no one has been able to take a break. People must be incentivised to bring in reusable cups for hot and cold drinks, so perhaps cups can be bought with hospital staff charity money, and recycling must be convenient. Projects may come with hidden benefits; for example, reducing cannulation and providing paracetamol in tablet form instead of intravenously both reduce the workload for staff.
Converting carbon savings into an easy-to-understand format is a great motivator. A good example of this is the difference between the carbon footprint of a Ventolin metered-dose inhaler (which equates to 175 miles in an average petrol-powered car) and that of a Salbutamol dry-powder inhaler (four miles). One Trust’s annual intravenous paracetamol use carried a similar carbon footprint to seven return flights to Perth, Australia. Procurement can tell you how many plastic cups your ED uses in a year, and you can calculate an equivalent carbon footprint for these. You will be shocked at the figures!
8. Be prepared to uncover some horrors
In many cases, things are done without consideration of the environmental impact because that’s the way they’ve always been done. In one Trust, it only took a couple of emails to stop an order for 87,000 water bottles per year.
You will find things that are shockingly wasteful, so much so that you can’t believe they have been allowed to continue. One example of this is the throwing away of crutches even when patients return them to the hospital, because there is no mechanism for cleaning and testing them.
Many people are busy and distracted, or they think that they aren’t able to make a difference because of their role or because they are just one person. Often when you talk to them you will find that there are green issues that have been bothering them for a while and they will support change.
9. Keep the momentum going
Once a change has been made, consider how you can keep people doing things in the new way. Engagement through nursing and doctor handovers or staff WhatsApp groups is more effective than through email, which often goes unread. Engaging people on the shopfloor is the most effective method of all.
Change takes time. Be prepared for people who change things back to how they were, such as using plastic cups because they’re cheaper than buying a new reusable mug. Recycling takes more time than throwing everything in one bin. Keep a rapport with staff and explain the reasons for change; this will help to embed the new way of doing things.
10. Finally – enjoy!
Turning your ED green involves travel up a huge learning curve. Along the way, you will gain insights into how the various departments of the hospital interact. It is hugely rewarding to see change start to happen and to see people beginning to support the work you are doing.