The next green pathways: where to apply the ELLA methodology within urology to improve environmental sustainability

Abstract

Introduction:

The National Health Service (NHS) accounts for 4%–5% of the UK’s greenhouse gas (GHG) emissions, approximately 20–25 million tonnes of carbon dioxide equivalent (CO2e) annually. Recognising the increasingly harmful effects of climate change on human health, the NHS aims to achieve net zero GHG emissions by 2045. The Environmental Lessons Learned and Applied (ELLA) methodology, developed and tested by the Getting It Right First Time (GIRFT) programme in the NHS in England, sets out a stepwise process for redesigning a clinical care pathway to reduce carbon emissions while maintaining or improving clinical standards.

Methods:

We reviewed peer-reviewed and grey literature to identify clinical pathways within urology with probable large decarbonisation potential if the ELLA methodology was applied.

Results and discussion:

Opportunities lie in applying the ELLA methodology to uro-oncology, UTIS and outpatient care, catheter care and elective surgery. Suspected cancer pathways and outpatients are some of the highest volume pathways. The highest intensity modifiable hotspots at a per-patient level likely include surgery, particularly robot-assisted. The ELLA methodology guides identification of sustainable interventions through care pathway mapping, rather than focusing on individual procedures. This allows a wide range of potential sustainable improvements to be considered and prioritised. This approach can potentially drive greater reductions in the GHG emissions of urological care and avoid the pitfall of single-action bias.

Conclusion:

We have applied the first steps of the ELLA framework to consider where future opportunities for decarbonisation of UK urology might lie. We have identified several pathways that have either very high levels of activity and/or very carbon-intensive processes. Full application of the ELLA framework to urological pathways can develop pragmatic strategies for decarbonising UK urology practice. We encourage multidisciplinary efforts to advance and build on the ideas raised and form action plans for the ongoing decarbonisation of urological care.

Level of evidence:

3