Introducing the updated Green Theatre Checklist
As a College, our efforts to promote and support sustainability in anaesthetic practice benefit from working collaboratively. The new updated Green Theatre Checklist is a great example of how a multidisciplinary and intercollegiate approach can lead to tangible improvements.
We’ve worked with the UK and Ireland Surgical Colleges, the Association of Anaesthetists and the Association for Perioperative Practice to update the Checklist, first launched in 2022, which provides all members of the surgical team with an accessible tool for introducing changes in their operating departments.
The Checklist seeks to apply the principles of sustainable healthcare to achieve the “triple bottom line” of environmental, social and economic impacts, while ensuring clinical standards of care are maintained, if not improved.
This new checklist follows in line with our updated Environmental Strategy for 2024-2027. As a College we are dedicated to reducing our specialty’s environmental footprint and the new Green Theatre Checklist gives surgical teams practical steps to work towards achieving reduced emissions.
What’s new in the 2025 update of the Green Theatre Checklist?
Version 2.0 of the Green Theatre Checklist clearly delineates interventions that can be implemented on the day as part of a preoperative checklist, and longer-term interventions that require wider stakeholder engagement and planning. One example of the latter is the recommendation to decommission nitrous oxide manifolds and switch to point-of-use cylinders. This aligns with the recommendations in our consensus statement published last year, which gave trusts and health boards the backing they need to get rid of leaky manifolds in hospitals, which will reduce greenhouse gas emissions and save money.
Minimising drug waste
The use of total intravenous anaesthesia (TIVA) is slowly increasing nationally, and we therefore need to be especially mindful of the correct disposal of drug waste and giving sets. Pharmaceuticals make up 20% of NHS England emissions and are causing growing concerns about environmental contamination. Some of the Intravenous agents that we use on a day-to-day basis are potentially especially deleterious to the environment if disposed of incorrectly.
Taking propofol as an example, the evidence suggests we can both reduce wastage and improve disposal. Advice such as ‘Don’t open unless needed’ seems obvious, but the data on wastage suggests we could all benefit from a reminder. Rationalising the concentration of propofol used will undoubtedly help to minimise waste too.
In some hospitals, research shows significant amounts of propofol are being disposed of incorrectly in sharp bins and general waste streams. The checklist reminds us to make sure we minimise the effects on our ecosystem by always disposing of pharmaceutical waste in the ‘blue bin’ to be incinerated.
Reduce, reuse, recycle
Implementing the checklist is reliant on the entire surgical team working together and reduce, reuse, recycle is a consistent theme. Avoiding unnecessary equipment and opting for reusables where possible is something we should all consider, for example in relation to laryngoscopes, body warmers, slide sheets, trays and soda lime canisters. It’s also worth evaluating sterile field and Personal Protective Equipment (PPE) requirements in light of the most recent evidence. The compendium of evidence that accompanies the checklist is designed to help you and your colleagues make the case for choosing reusables on environmental and financial grounds.
If your department is already using the Green Theatre Checklist, then I hope you find this updated version helps advance your sustainability efforts. If it’s new to you, then I can say from first-hand experience that it’s a very accessible and practical tool that provides a shared focus for the whole surgical team. If used regularly, the checklist can also serve as a scorecard to monitor progress and demonstrate achievements towards more sustainable practice, which can be rewarding and motivating.
As more and more teams throughout the country start using the checklist, I’m optimistic about how our efforts can multiply and make a significant reduction in our overall carbon footprint peri-operatively.