How to decarbonise a care pathway
The care pathways approach allows the appraisal the entire patient journey, identifying areas where the environmental impact of that care pathway can be reduced without compromising patient safety and experience.
The SHC method sets out how to undertake a care pathway assessment using life cycle assessment (LCA), and can be applied at different levels of depth and data quality depending on your objectives and resources – from a high-level estimate through to a full, primary-data-led LCA study.
If you would like to produce a high-level estimate, we suggest using the care pathways carbon calculator: this is free to access and has been deliberately kept simple and entry-level, drawing on secondary data and higher materiality thresholds, so it should be treated as an indicative estimate rather than a substitute for a more detailed study. Other tools are available that support a more detailed application of the SHC method, such as CARESA.
Ways to decarbonise clinical care
Once you have estimated the carbon footprint of a care pathway, interpret the results and identify likely carbon hotspots within the pathway. Those hotspots are where changes to care delivery are likely to have the most impact on reducing environmental impact. Below are some suggested routes for decarbonising clinical care delivery, based on common hotspots.
General actions
- Manage waste appropriately, ensuring it is segregated and disposed of in the least carbon-intensive method possible
- Utilise a paper-free environment where possible
- Turn off equipment and lighting when not in use
- Encourage active or communal travel (cycling, walking, public transport) for staff and, where relevant, patients
- Reduce use of unnecessary consumables (e.g. non-sterile gloves) and use reusable items where available and clinically appropriate
Prescribing and medicines
- Avoid unnecessary prescribing, medicines wastage, over-prescribing and unnecessary polypharmacy
- Undertake regular medication review, including review of discharge medication
- Practise antimicrobial stewardship
- Convert to oral medication promptly where appropriate
- Focus on medicines optimisation and consider greener alternatives where available, including greener inhaler prescribing
- Reduce use of carbon-intensive medicines such as Entonox
Community care
- Avoid unnecessary referrals, tests and imaging requests, and avoid over-diagnosis
- Reduce travel through telephone or video clinics where clinically appropriate
- Provide streamlined, efficient patient care to enable same-day outpatient clinics, diagnostic tests or pre-operative assessments, minimising the need for separate visits
- Focus on disease prevention and health promotion
Hospital care
- Avoid unnecessary referrals, tests and invasive procedures such as cannulation and venepuncture
- Avoid unnecessary additional clinical interventions where not required, e.g. catheterisation, additional access lines and histology samples
- Perform operations as day-case procedures where clinically safe and appropriate
- Use local, regional or intravenous anaesthetic where possible; avoid desflurane or nitrous oxide where alternatives exist
- Reduce use of single-use consumables where clinically appropriate
- Rationalise instrument trays and the use of additional instruments
