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How to Improve

So you have heard of Quality Improvement Projectsa great way to enact change in our health systems. Now we welcome to the improvement scene Sustainability in Quality Improvement or SusQiDeveloped by the team at the Centre for Sustainable Healthcare (CSH) it is an essential tool to to drive incremental change towards a more ethical, sustainable health system.

But don't take my word for it. Click on the logo at the bottom of the page to be directed to their website, where you will learn how to undertake SusQi  and find useful examples of successful projects. 


Before you head to the wonderful world of SusQi a word on measurement. With so much low hanging fruit that is ripe for the picking its very tempting to jump in and enact change without giving measurement a thought. It can often be really challenging, so why do we bother?

  • Without it how do you know if you have made a difference?

  • It lets you know if your interventions have worked.

  • A positive change acts as a driver for more buy in from stakeholders.

"Give me some examples of measurement in sustainable anaesthesia"

A great way we can reduce our carbon footprint in anaesthesia is by doing the following:

  • Reduce/Stop using Desflurane

  • Reduce/Stop using Nitrous Oxide

  • If using volatiles use Sevoflurane at LOW Flows

  • Use greener alternatives to volatiles - TIVA, Regional Anaesthesia, Local + Sedation

If we want to measure the effect here we can measure volatile/gas use or staff survey data. Each method has its pros and cons.

measurment table.png

Getting the data of gas and volatile usage can be tricky. The first port of call should be pharmacy, then estates and if still no luck speak to the procurement team. The data you receive can be complicated! 

Here is an example of volatile data you may receive. It will often include the number of bottles of vapor supplied to each area of use eg Obstetric Theatres, Main Theatres...

volatile data example.png

Nitrous Oxide and Entonox can be even more overwhelming. You are often sent a vast spreadsheet from the medical gas supplier. What you need to take not of it the empty cylinder returns data as this will give you an indication of what has been used. 

n20 data.png
N20 cylinder size.png

Add up the number of each cylinder size eg 30 Size E. Then multiply by the volume of that cylinder type

Carbon factor.png

Now you have volumes for volatile and nitrous oxide use. If you multiply them by their carbon factor you can work out the equivalent weight of CO2 and thus the carbon footprint.

We can then go one step further and turn it into equivalent km driven in a car.

An average car produces 120gCO2/km

So in this example (real data) the total carbon footprint from one trusts year of anaesthesia was 3457.45 Tonnes CO2e.

Or 3457450000g / 120 = >28 million km in a car!

Or 718 times round the Earth!

So you see, data is powerful.

Now go jump into the world SusQi. Click the clink below.

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