Abstract
Background
Climate change is arguably the greatest threat to global health of the 21st century. Although cataract surgery is a major contributor to global greenhouse gas emissions, recent literature review identified a paucity of evidence-based strategies for improving the environmental impact of cataract services. Our study aimed to assess the effectiveness of a departmental Delphi process for improving cataract services’ environmental sustainability.
Methods
All members of ophthalmology theatre teams in a UK teaching hospital were invited to participate in a three-stage Delphi process. Team members were surveyed for suggestions for reducing the department’s environmental impact. Suggested interventions were refined during a plenary face-to-face discussion and ranked. The highest ranked interventions were combined into a mutually agreed action plan. Data on the economic and environmental cost of cataract services was collected prior to and six months after the Delphi process using the Eyefficiency mobile application.
Results
Twenty-three interventions were suggested by a range of staff cadres. Interventions were ranked by 24 team members. The 2nd, 4th, 5th, 8th and 11th ranked interventions were combined into an “Eco-packs” project in collaboration with suppliers (Bausch + Lomb), saving 675 kg of waste and 350 kg of CO2 equivalent annually.
Conclusions
The Delphi process is an effective method for provoking departmental engagement with the sustainability agenda that we would encourage all ophthalmology departments to consider utilising. The baseline per case CO2 equivalent measured in our department was reproducible and could serve as a maximum benchmark to be improved upon.
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Data availability
The datasets generated during the current study are available from the corresponding author on reasonable request.
References
Costello A, Abbas M, Allen A, Ball S, Bell S, Bellamy R, et al. Managing the health effects of climate change. Lancet Univ Coll Lond Inst Glob Health Comm Lancet. 2009;373:1693–733.
Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Beagley J, Belesova K, et al. The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. Lancet. 2020;397:129–70.
Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Belesova K, Boykoff M, et al. The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate. Lancet. 2019;394:1836–78.
Pichler P-P, Jaccard IS, Weisz U, Weisz H. International comparison of health care carbon footprints. Environ Res Lett. 2019;14:064004.
Tennison I, Roschnik S, Ashby B, Boyd R, Hamilton I, Oreszczyn T, et al. Health care’s response to climate change: a carbon footprint assessment of the NHS in England. Lancet Planet Heal. 2021;5:e84–92.
NHS England, NHS Improvement. Delivering a “Net Zero” National Health Service. 2020. Available from: https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf.
National Health Service Digital. Hospital Outpatient Activity. 2018-19. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/hospital-outpatient-activity/2018-19.
Donachie PHJ, Sarrow JM. National Ophthalmology Database Audit: Year 5 Annual Report – The Fourth Prospective Report of the National Ophthalmology Database Audit. The Royal College of Ophthalmologists. 2020.
MacNeill AJ, Lillywhite R, Brown CJ. The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems. Lancet Planet Heal. 2017;1:e360–7.
Morris DS, Wright T, Somner JEA, Connor A. The carbon footprint of cataract surgery. Eye. 2013;27:495–501.
Buchan JC, Norman P, Shickle D, Cassels-Brown A, MacEwen C. Failing to plan and planning to fail. Can we predict the future growth of demand on UK Eye Care Services? Eye. 2019;33:1029–31.
Buchan JC, Thiel CL, Steyn A, Somner J, Venkatesh R, Burton MJ, et al. Addressing the environmental sustainability of eye health-care delivery: a scoping review. Lancet Planet Heal. 2022;6:e524–34.
Fink A, Kosecoff J, Chassin M, Brook RH. Consensus methods: Characteristics and guidelines for use. Am J Public Health. 1984;74:979–83.
Mathewson PA, Williams GP, Watson SL, Hodson J, Bron AJ, Rauz S. Defining ocular surface disease activity and damage indices by an International Delphi Consultation. Ocul Surf. 2017;15:97–111.
Douglas RS, Tsirbas A, Gordon M, Lee D, Khadavi N, Garneau HC, et al. Development of criteria for evaluating clinical response in thyroid eye disease using a modified delphi technique. Arch Ophthalmol. 2009;127:1155–60.
Buchan JC, Dean WH, Foster A, Burton MJ. What are the priorities for improving cataract surgical outcomes in Africa? Results of a Delphi exercise. Int Ophthalmol. 2018;38:1409–14.
Hatemi G, Merkel PA, Hamuryudan V, Boers M, Direskeneli H, Aydin SZ, et al. Outcome measures used in clinical trials for Behçet syndrome: a systematic review. J Rheumatol. 2014;41:599–612.
Goel H, Wemyss TA, Harris T, Steinbach I, Stancliffe R, Cassels-Brown A, et al. Improving productivity, costs and environmental impact in International Eye Health Services: using the “Eyefficiency” cataract surgical services auditing tool to assess the value of cataract surgical services. BMJ Open Ophthalmol. 2021;6:e000642.
Thiel CL, Cassels-Brown A, Goel H, Stancliffe R, Steinbach I, Thomas P, et al. Utilizing off-the-shelf LCA methods to develop a ‘triple bottom line’ auditing tool for global cataract surgical services. Resour Conserv Recycl. 2020;158:104805.
Latta M, Shaw C, Gale J. The carbon footprint of cataract surgery in Wellington. N Z Med J. 2021;134:13–21.
Health Research Authority. Do I need NHS REC review? Available from: http://www.hra-decisiontools.org.uk/ethics/. Accessed 22nd December 2023.
Watts N, Adger WN, Agnolucci P, Blackstock J, Byass P, Cai W, et al. Health and climate change: policy responses to protect public health. Lancet. 2015;386:1861–914.
McGill B, Corbett L, Grunseit AC, Irving M, O’hara BJ. Co-produce, co-design, co-create, or co-construct—who does it and how is it done in chronic disease prevention? A scoping review. Healthc. 2022;10:647.
Department for Energy Security and Net Zero, Department for Environmental Food and Rural Affairs. Greenhouse gas reporting: conversion factors 2023. 2023. https://www.gov.uk/government/publications/greenhouse-gas-reporting-conversion-factors-2023. Accessed 22nd December 2023.
Public Health England. Atlas of variation in risk factors and healthcare for vision in England. 2021. Available from: https://fingertips.phe.org.uk/profile/atlas-of-variation.
Bell CM, Hatch WV, Cernat G, Urbach DR. Surgeon volumes and selected patient outcomes in cataract surgery. A population-based analysis. Ophthalmology. 2007;114:405–10.
Dean WH, Gichuhi S, Buchan JC, Makupa W, Mukome A, Otiti-Sengeri J, et al. Intense simulation-based surgical education for manual small-incision cataract surgery: the ophthalmic learning and improvement initiative in cataract surgery randomized clinical trial in Kenya, Tanzania, Uganda, and Zimbabwe. JAMA Ophthalmol. 2021;139:9–15.
Dean WH, Buchan J, Gichuhi S, Philippin H, Arunga S, Mukome A, et al. Simulation-based surgical education for glaucoma versus conventional training alone: the GLAucoma Simulated Surgery (GLASS) trial. A multicentre, multicountry, randomised controlled, investigator-masked educational intervention efficacy trial in Kenya, So. Br J Ophthalmol. 2022;106:863–9.
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JB and ACB conceptualised study. JB was Delphi process coordinator. MS and AD collected Eyefficiency data. All authors contributed to data analysis. JM and JB drafted and revised manuscript. All authors offered comments and agreed the final manuscript.
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Malcolm, J., Dodd, A., Shaikh, M. et al. Reducing the carbon footprint of cataract surgery: co-creating solutions with a departmental Delphi process. Eye 38, 1349–1354 (2024). https://doi.org/10.1038/s41433-023-02902-4
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DOI: https://doi.org/10.1038/s41433-023-02902-4