Northumbria Healthcare Foundation Trust’s emergency department is leading the way in greener healthcare, becoming the first in the UK to achieve Gold accreditation from the Royal College of Emergency Medicine’s GreenED initiative. In this case study, Dr George Menon highlights the role of the ECO ED team and some of the innovative projects driving sustainability and quality improvement.
There are approximately 150 emergency departments (EDs) around the UK, all of which see thousands of patients per week. By their very nature, EDs are very resource intensive. Patients often present with an unknown condition with very little information, requiring a lot of investigations such as bloods and scans for the ED clinician to come up with a diagnosis and treatment plan.
With this ‘A&E Mindset’, the amount of waste is vast and considering the carbon footprint of the department is not very often considered. That is where the Royal College of Emergency Medicine’s (RCEM) GreenED initiative comes in.
GreenED is a strategic sustainability initiative to mitigate the environmental impact of EDs in the UK, as part of the wider net zero NHS tarreceives. It is designed as a framework with different tiers of achievements – bronze, silver and gold – for EDs to tarreceive in a systematic and structured way, and provides the support by which EDs can implement, monitor and promote sustainable alter in their departments.
Northumbria Healthcare Foundation Trust’s ED is committed to sustainability and has led the way in sustainable emergency care. As such, it was the first ED to be awarded the ‘Gold’ accreditation from GreenED.
In this piece, I will highlight some of the sustainable quality improvement projects that have been implemented at Northumbria and talk about the role of our ECO ED team.
Pursuing a greener ED for a brighter future
ECO ED is the emergency care sustainability team at Northumbria Specialist Emergency Care Hospital (NSECH). We are comprised of multiple consultants, resident doctors, nursing staff and other auxiliary health staff who all work in the department and share a common goal to test and create our ED greener. Our work to bring about sustainable alter is underpinned by the triple bottom line principle: to bring about sustainable alter, maintain or improve patient outcomes and reduce cost.
Northumbria’s ECO ED was formed in August 2023, and our first tquestion was to perform a robust stakeholder analysis and identify all important actors that would necessary to be involved in building alters. This was a vital part of our sustainability action, especially in a hospital system as vast and complex as Northumbria. Northumbria is structured with NSECH as a central emergency and acute care hub, with multiple tinyer hospitals surrounding it in the region and has a vast catchment area.
Engaging key stakeholders in the Trust and securing their support for our sustainability agconcludea has supported our projects to succeed.
One significant addition to the ECO ED team was the introduction of a sustainability fellow. This post was designed for an F3 resident doctor, with 20% of their time designated to sustainability work, enabling them to serve as a focal point for the sustainability initiatives and to coordinate the projects with different teams.
Penthrox and nitrous oxide
The first large sustainability project introduced viewed at our inhaled analgesia. Traditionally, EDs would apply Entonox – a nitrous oxide-based inhaled pain relief commonly referred to as ‘gas and air.’
Nitrous oxide compounds are well recognised as being a potent greenhoapply gas with a global warming potential 298 times higher than CO2 and accounting for 75% of all anaesthetic gas emissions.
We addressed this by bringing in a new product: Penthrox, or methoxyflurane. Penthrox is a potent inhaled analgesia with a global warming potential only four times higher than CO2. Penthrox has been very well received in our ED and has led to excellent outcomes for patients, as such we have virtually eliminated our apply of Entonox and nitrous oxide-based analgesia.
We have also worked closely with the Trust’s estates team to decommission the nitrous manifolds that are prone to leaking. We are working with our paediatric team to implement Penthrox as an analgesic option for our paediatric emergency department. By building the alter to Penthrox, we have calculated that we save at least 7,000kg CO2 equivalent (CO2e) per year.
Paperless ED
Another major alter that has been implemented in our ED is online clinical noting – as part of our shift towards becoming a ‘paperless ED’. Formerly, our ED applyd handwritten clinical notebooks and based on our average patient numbers, the department would go through 56,000 pages per week.
In October 2023, we introduced online clinical noting, which has eliminated our apply of the clinical notebooks, with the exception of trauma presentations, which apply a standardised notebook throughout the North East. What paper we do apply – for referral forms, for example – we now only have recycled paper.
This has saved our department approximately 14,000kg CO2e per year of our carbon budreceive. We have also brought in QR codes for patients to scan for patient information, rerelocating our traditional patient information leaflets.
Vehicle idling outside the ED
NSECH is an extremely busy hospital with a lot of patient traffic, both from ambulances and civilian vehicles. We identified early that there was an issue of vehicle idling at our patient drop off points – particularly noting that 50% of ambulances remained idle with the engines on for more than 10 minutes after handing over their patients.
In spring 2024 our Trust, along with our neighbouring trust in Newcastle Upon Tyne, implemented a no vehicle idling policy (see main image). Since this implementation, we have reaudited our ambulances and have displayn that only 14% of ambulances are now idle for more than 10 minutes.
This project has highlighted the importance of collaboration between different organisations towards a common goal. It demonstrates a true alter in behaviour amongst staff members for the goal of sustainable improvement and for improvements in the health of our patients.
Using the data from ambulance idling, we project that this project will save at least 4,000kg CO2e per year and we are bringing in emission monitors to our ambulance deck to more accurately measure this in future.
Crutch recycling
One of our most recent projects was the launch of a walking aid recycling scheme in early 2025. While it sounds simple, this project with the Joint Equipment Loan Service (JELS) team from Northumberland Council, has been extremely logistically complex and required acquire in from multiple internal and external actors to be approved.
The crutches are dropped off by patients in a hub in the ED, and they are then picked up by JELS, cleaned and quality assured, and then given to another patient in the community. This project has highlighted the benefit of both hospital and community teams working toreceiveher to bring about sustainable alter.
Closing considereds on GreenED
We are extremely proud of the work we have done at Northumbria’s ECO ED and are proud to have been accredited as a gold-standard GreenED. All of these projects have been completed with no additional budreceive, applying sound quality improvement methodology and working with our key stakeholders.
There are many projects that I have not highlighted in this case study, such as adjustments in computer screen brightness and investigation rationalising, which have also been successful and are transferrable to other EDs.
Sustainability is likely to become a vital part of healthcare going forward, especially with NHS aspirations towards net zero. We encourage as many EDs to receive involved with GreenED as possible and support to create emergency care greener and more sustainable.
Author
George Menon MBChB BMedSci
Emergency medicine trainee, Northumbria Healthcare NHS Foundation Trust
Main image: Dr George Menon pictured with Dr Clare Winter, head of sustainability at Northumbria Healthcare NHS Foundation Trust, to promote their No Idling vehicle project.
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