James Lind Alliance and Greener Operations search for sustainable peri-operative practice

The James Lind Alliance (JLA) is an organisation that aims to improve the direction of research, through a formal and open process. Much investigation is currently performed based on researchers’ perception of what they believe to be important outcomes, as well as the established research infrastructure in an institution or department. The JLA, funded by the NIHR, starts with the premise that patients and carers are also central to determining any such priorities, and aims to establish these priorities through a structured sequence of stakeholder and public consultation, discussion and refinement led by a Priority Setting Partnership (PSP) Steering Group.

Such a group was set up to investigate sustainable perioperative practice at the end of 2020, using the short title ‘Greener Operations’. The project was funded by the Manchester Foundation Trust Charity and co-lead by consultant anaesthetist Cliff Shelton and retired consultant general surgeon and medical examiner David Jones, both of Wythenshawe Hospital, with senior anaesthetic trainees Max Clayton-Smith and Hrishi Narayanan acting as information specialists for the project. The core team were supported by a multidisciplinary steering group that also included patient and public representation, and an advisor from the JLA, Jonathan Gower. Greener Operations was supported by 25 partner organisations, including the Association of Anaesthetists, who provided an invaluable link to clinicians, patients and members of the public.

An initial call for potential research questions (areas of uncertainty) returned nearly 2000 suggestions, of which just over 1600 were considered to be within the scope of the investigation. These suggestions were collated and refined to produce a long-list of 60 answerable questions, and stakeholders were surveyed a second time to reduce these to a manageable shortlist of 24.

Finally, a series of round-table discussions, hosted at the Association of Anaesthetists headquarters on 15 June, produced a ranked ‘top 10’ research priorities [1]. It is hoped that these will focus the efforts of researchers and funders to conduct research in the field of sustainable peri-operative care that meets the needs of the ultimate ‘end users’ of research: clinicians, members of the public, carers and patients.

Mike Kinsella
Association of Anaesthetists Council Member and Member of the Greener Operations PSP Steering Group 

Twitter: @mikekinsella10

References 

1. James Lind Alliance. Greener Operations: sustainable peri-operative practice, 2022. https://www.jla.nihr.ac.uk/priority-setting-partnerships/greener-operations-sustainable-perioperative-practice/ (accessed 26/6/2022).

Greener Operations: Sustainable Peri-Operative Practice Top 10

1. How can more sustainable reusable equipment safely be used during and around the time of an operation? 
2. How can healthcare organisations more sustainably procure (obtain) medicines, equipment and items used during and around the time of an operation? 
3. How can healthcare professionals who deliver care during and around the time of an operation be encouraged to adopt sustainable actions in practice? 
4. Can more efficient use of operating theatres and associated practices reduce the environmental impact of operations? 
5. How can the amount of waste generated during and around the time of an operation be minimised? 
6. How do we measure and compare the short- and long-term environmental impacts of surgical and non-surgical treatments for the same condition? 
7. What is the environmental impact of different anaesthetic techniques (e.g., different types of general, regional and local anaesthesia) used for the same operation? 
8. How should the environmental impact of an operation be weighed against its clinical outcomes and financial costs? 
9. How can environmental sustainability be incorporated into the organisational management of operating theatres? 
10. What are the most sustainable forms of effective infection prevention and control used around the time of an operation (e.g., PPE, drapes, clean air ventilation)?