The Sustainable Clinician - MEDACT · SUSTAINABLE HEALTHCARE Sustainability as a domain of quality...
Transcript of The Sustainable Clinician - MEDACT · SUSTAINABLE HEALTHCARE Sustainability as a domain of quality...
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Dr.FrancesMortimer,MedicalDirectorCentreforSustainableHealthcare
Medact annualforum9th December2016
TheSustainableClinician
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“Ourvisionofsustainablehealthandcare:Asustainablehealthandcaresystemworkswithintheavailableenvironmentalandsocialresourcesprotectingandimprovinghealthnowandforfuturegenerations.”
Protectinghealthoffuturegenerations
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CENTRE forSUSTAINABLEHEALTHCARE
Sustainabilityasadomainofquality
SustainablePatient CentredEquitable
Efficient
Effective
Timely
Safe
Dr Donal O’DonoghueNational Clinical Director
for Kidney Care
Seealso:Atkinson,S.etal.Defining QualityandQualityImprovement.Clin Medvol.10,no.6537-539(2010)
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Sustainable value in healthcare:
Academy of Medical Royal Colleges, 2016 (with CSH)
(goods – harms)
Informedbypatientvalues
outcomesValue =
environmental + social + financial costs(the “triple bottom line”)
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CENTRE forSUSTAINABLEHEALTHCARE
EstatesClinical
Carbonfootprint– NHSEngland
Procured(pharmaceuticals,equipment,everythingelse)
Travel
Buildingenergyuse
Commissioned
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CENTRE forSUSTAINABLEHEALTHCARE
NHScarbonfootprint– goodsandservicescarbonhotspots
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CENTRE forSUSTAINABLEHEALTHCARE
Summaryofprogress
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Sustainableclinicalpractice
Reducecarbonwithoutreducing
health
Reduceactivity
Prevention
Selfcare
Leanpathways
Reducecarbonintensity
Lowcarbonalternatives
Sustainableestates
Mortimer-F.TheSustainable PhysicianClinicalMedicine2010,Vol10,No2:110–11
Outcomeneeded
Secondarydrivers
Primarydriver
Primarydriver
CENTRE forSUSTAINABLEHEALTHCARE
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Sustainableclinicalpractice
Reducecarbonwithoutreducing
health
Reduceactivity
Prevention
Selfcare
Leanpathways
Reducecarbonintensity
Lowcarbonalternatives
Sustainableestates
Mortimer-F.TheSustainable PhysicianClinicalMedicine2010,Vol10,No2:110–11
Outcomeneeded
Secondarydrivers
Primarydriver
Primarydriver
CENTRE forSUSTAINABLEHEALTHCARE
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CENTRE forSUSTAINABLEHEALTHCARE
Fiveyearforwardview
• ‘Gettingseriousaboutprevention’
• ‘Empoweringpatients’
• ‘Newcaremodels’
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Sustainableclinicalpractice
Reducecarbonwithoutreducing
health
Reduceactivity
Prevention
Selfcare
Leanpathways
Reducecarbonintensity
Lowcarbonalternatives
Sustainableestates
Mortimer-F.TheSustainable PhysicianClinicalMedicine2010,Vol10,No2:110–11
Sustainableclinicalpractice
Outcomeneeded
Secondarydrivers
Primarydriver
Primarydriver
Infrastructure&processCENTRE for
SUSTAINABLEHEALTHCARE
e.g.drypowderinhalers(1/18xcarbonofMDI)
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Thesustainableclinician
Advocacy
Qualityimprovement
Resourcemanagement
Clinicalpractice
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Academy of Medical Royal Colleges, 2014 (with CSH)
Clinicalpractice?
Dr.HughRayner
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QueenMargaretHospitalRenalUnit,FifeGreenNurse:MaryThomson
2009
14,000dialysistreatmentsperyear– 2.9kgwasteeach
40.3tonnes /year
100%incineratedasclinicalwaste
Resourcemanagement
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CENTRE forSUSTAINABLEHEALTHCARE
• Normalsalinebags,togetherwithprimingsetsanddrainagebags,replacedwithonlineinfusion
• Dressingpacksreplacedwithindividualitems
• IVinfusion>bolus(6,175antibioticdoses/yr)
• Introducedwastesegregation
Queen Margaret HospitalNHS Fife
Resourcemanagement(2)
Saving:£45,000/yr
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CENTRE forSUSTAINABLEHEALTHCARE
SustainableQI
Mortimer, F.,insubmission 2016
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SusQI:improvingpre-oppathwaysAprimarycareteamnoticedthatsomepatientswhowerereferredforhipand
kneereplacementswerebeingreferredbacktotheGPsurgeryafterpre-operativeassessmentatthelocalhospital.Thiswasbecauseparameters,such
asbloodpressure,wereeitheroutsidethetargetrangeorwerenotcommunicatedproperlyinthereferralinformation.Anauditrevealedthat1in
6patientsloopedthroughthesystem– 10/year.
Activity Outcome £’s CO2e Social
ExtraGPconsult [delaytosurgery]
£451 18kg2 Patient&carertime/stress
ExtraHospitalconsult
[delaytosurgery]
£1121 23kg2 Patient&carertime/stress(parking…)
Total (for 10loops) £1570 410kg
1. Unit CostsofHealthandCare,PSSRU,December2015.Availableat:http://www.pssru.ac.uk/project-pages/unit-costs/2015/index.php
2. Carbon Hotspotsupdate forthehealth andcaresectorinEngland2015,SustainableDevelopmentUnit, January2016.
CharlieKenward,SevernGPST3SustainabilityScholar2014-15
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Advocacy
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Advocacy
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http://networks.sustainablehealthcare.org.uk
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http://sustainablehealthcare.org.ukfrances.mortimer@sustainablehealthcare.org.uk