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Bevan Exemplar Cohort 8 Projects

Eliminating WOORST(Waste Originating from Orthopaedic Surgery for Trauma): Novel model for day case surgery

Pushkar Prafulla Joshi

Betsi Cadwaladr University Health Board

This project is aimed at developing a safe, economical and environmentally sustainable pathway of delivering trauma care service within the NHS. This will have a positive impact on health and well-being which includes healthcare staff delivering the care and patients and families receiving health care.

Orthopaedic trauma surgery is a major burden on the NHS. Hip fractures alone mount to 75,000 admissions annually. This is an immense social and economical load to the strained NHS service. Trauma surgery also adds to the carbon footprint of the hospitals. Typically a single surgery equals to carbon emission after having driven a petrol car for 450 miles.

In line with the vision of NET ZERO NHS by 2040, we will aim to reduce carbon footprint of the five most commonly performed procedures in orthopaedic trauma surgery i.e. Hip hemiarthroplasty, DHS fixation, Ankle fracture fixation, Distal radius fracture fixation, infection/wound debridement.

A single day ward admission accounts for 29% carbon emission of a hospital. We will aim to reduce patient visits to clinic/ward admissions through a one stop shop and day case fracture clinic surgery for mobile orthopaedic trauma patients which will invariably reduce carbon footprint. This would aid in making orthopaedic trauma service delivery economical, sustainable, greener for the environment and safe for patients.


Reduce carbon footprint of orthopaedic trauma surgery.


  • To assess waste generated in orthopaedic trauma theatre.
  • To reassess the amount of reduction in waste generation after implementing      sustainable changes.
  • Audit and re audit “GREEN THEATRE CHECKLIST” proposed by Royal College of Surgeons.
  • Cost effectiveness of fracture clinic day case surgery.

Anticipated outcomes:

Fracture clinic day case surgery and one stop shop: Significant reduction in inpatient admissions, hospital and clinic visits, improved patient satisfaction and minimal cancellation of planned surgery are the highlighting benefits of this model. It has been proven to be very economical.

Operating theatres: Reducing the carbon emission by working on direct modifiable factors is an immense boost towards Net Zero NHS drive.

The outcomes of this project will be applicable nationally and internationally. This will improve the economic and environmental sustainability of surgery within the NHS.