Greener Operations: a James Lind Alliance Priority Setting Partnership on environmentally sustainable peri-operative practice
Authors: Clayton-Smith Max , Narayanan Hrishi , Shelton Clifford , Bates Louise , Brennan Fiona , Deido Beck , Donnellon Mike , Dorey Jennifer , Evans Bob , Gower Jonathan , Hamdaoui Yasmina , Hitchman John , Kinsella Stephen Michael , Knagg Rebecca , Lawson Cathy , Morris Daniel , Pegna Victoria , Radcliffe Tracey , Schaff Olivia , Sheppard Tim , Strong Jennifer , Jones David 
Published: July 2022

Objectives

To agree the ‘top 10’ research priorities for environmentally sustainable peri-operative practice.

Design

surveys and literature review; final consensus workshop using a nominal group technique. Setting: UK-based.

Participants

healthcare professionals, patients, carers, and the public.

Outcome measures

initial survey- suggested research questions; interim survey- shortlist of ‘indicative’ questions (the 20 most frequently nominated by patients, carers and the public, and healthcare professionals); final workshop- ranked research priorities.

Results

initial survey- 1,926 suggestions by 296 respondents, refined into 60 indicative questions. Interim survey- 325 respondents. Final workshop- 21 participants agreed the ‘top 10’:

How can more sustainable reusable equipment safely be used during and around the time of an operation?

How can healthcare organisations more sustainably procure (obtain) medicines, equipment and items used during and around the time of an operation?

How can healthcare professionals who deliver care during and around the time of an operation be encouraged to adopt sustainable actions in practice?

Can more efficient use of operating theatres and associated practices reduce the environmental impact of operations?

How can the amount of waste generated during and around the time of an operation be minimised?

How do we measure and compare the short- and long-term environmental impacts of surgical and non-surgical treatments for the same condition?

What is the environmental impact of different anaesthetic techniques (e.g., different types of general, regional and local anaesthesia) used for the same operation?

How should the environmental impact of an operation be weighed against its clinical outcomes and financial costs?

How can environmental sustainability be incorporated into the organisational management of operating theatres?

What are the most sustainable forms of effective infection prevention and control used around the time of an operation (e.g., PPE, drapes, clean air ventilation)?

Conclusions

a broad range of ‘end-users’ have identified research priorities for sustainable peri-operative care.

Strengths and Limitations of this Study

We have defined the top 10 research priorities according to healthcare professionals, patients, carers, and members of the public, in an important and expanding area of health research.

To our knowledge, this is the first research priority setting partnership in any field of sustainable healthcare.

Patients, carers, and members of the public comprised 21% of survey respondents overall, a smaller proportion than in many priority setting partnerships. This may have been because of the online methods used (due in part to the COVID-19 pandemic) or the novel subject matter.

The James Lind Alliance process is consensus-based, transparent, and includes measures to ensure that patient, carer and public opinions are represented.

The scope of our work was limited to ‘care provided from or in the secondary care setting to patients who may benefit from surgical management’ so does not include the full patient journey; more sustainability-focussed priority setting partnerships would be beneficial in the future.

Original Protocol of the Study

See https://www.jla.nihr.ac.uk/documents/greener-operations-sustainable-peri-operative-practice-psp-protocol/27106