Kylie Feely. Photo: Christopher Hopkins
Kylie Feely is the equipment nurse at Sunshine Hospital’s 13-bed intensive care unit. She’s recently had her efforts to improve sustainability within the unit, and the wider hospital, published in Australian Critical Care. She also shared her work at the ANMF (Vic Branch) Health and Environmental Sustainability Conference – specifically on how low-value healthcare costs money and the planet for little to no clinical outcome.
‘Low-value healthcare comprises health interventions or care that provide little or no benefit to the patient and may, in fact, cause harm,’ Kylie began. ‘In terms of sustainability, many interventions deemed as low-value care have a considerable impact on climate. Daily bloods on a palliative patient. Really? And grip socks,’ she added – to much applause. ‘They don’t work. They don’t stop falls. So why has it taken so long to de-implement them?’
Targeting such low-value care can be an effective way to begin making positive sustainability changes at your workplace, Kylie said. As a bonus, it will likely save your hospital money.
Reusable linen: good for the patient, planet and pocket
The key focus of Kylie’s article in Australian Critical Care is Sunshine ICU’s move from disposable to reusable linen. This process began in 2021 under the stewardship of Forbes McGain, an intensive care physician at Western Health and an associate professor (medicine) at the University of Melbourne, specialising in healthcare sustainability.
‘Forbes floated the idea of reusable isolation gowns,’ Kylie explained. ‘He’d read the article by Vozzola et al[1] that found a 28 per cent reduction in energy consumption, a 30 per cent reduction in greenhouse gas emissions and a 93 per cent reduction in solid waste generation. It also debunked the theory that reusable uses more water. They found that the environmental savings from manufacturing fewer gowns more than offset the laundry.’
Working with Forbes, Kylie and her team collaborated with Linen Services Australia to design, test and implement reusable gowns. They were a success, so the team began looking at what other linen was a problem.
‘We noticed a significant problem with staff double padding under a patient,’ she said. ‘A slide sheet, a sheet, a pinkie. Then four or five blueys on top of that, then a nappy. And then the patient. Why? The air mattress doesn’t work effectively if you’ve got five or six layers of linen between the patient and the mattress. And disposable doesn’t even breathe.’
This is a great example of low-value care, Kylie said. She collected their usage data from Health Share Victoria and learned that they were using over 1500 kilograms a year of blueys and pinkies. ‘That’s about the weight of a hippopotamus every year in our 13-bed unit. Break that down and you’re looking at 115 kilos per bed per year.’
Following implementation of the reusable isolation gowns, blueys and pinkies, the unit saw a significant drop in overall usage, including a huge decrease in nappy use. ‘We dropped our pinkies and blueys by about 8000 items. And we only used 760 nappies a year, which is 4700 fewer than the previous year.’
Of course, if the reusable linen wasn’t good for patients, it wouldn’t work. But a cohort study of RiskMans pre and post roll out showed that the incidence of pressure injuries ‘was significantly reduced after reusable linen was implemented compared to that observed while using the disposable linen’.
Other cost-saving sustainability initiatives
Kylie and her colleagues were keen to find further improvements and savings. First up was switching to completely reusable HoverMatts.
‘In 12 months, Sunshine ICU spent $35,000 on disposable HoverMatts, creating 243 kilograms of waste,’ she noted. ‘I looked at the entire hospital. It’s over $300,000 for one health service on disposable HoverMatts.’
After confirming they would be able to clean reusable matts, Kylie purchased two. ‘They are more expensive. They cost about three grand for a 50-inch mat. But in the long term it’s going to save us a lot of money.’
They have been some issues, Kylie noted. For example, sometimes the matts get lost. ‘One ended up at St Vincent’s Hospital ICU. I rang them and said “Hey, can you send it back?”
“How do you know it’s here?” they asked.
‘Because it’s air tagged, I said.’
Another project Kylie has embarked on involves reducing the number of expired consumables in ICU. ‘This isn’t even low-value healthcare. It’s zero-value healthcare. And it’s costly to both the health service and the environment.’
She set up a simple Excel spreadsheet and logged all the expired stock. ‘In ICU, over the last financial year, we threw out 3410 expired, unopened products,’ she said. ‘That’s an average of 284 products per month at a cost of $2,100 per month.’
Kylie identified several contributing factors. ‘A lot of products are bought for a specific patient, then after discharge it’s just left over. Or I have to buy a box of 100 when I only need one, and I’ve got 99 sitting on my shelf going out of date. There’s also ICU-specific stock that has been over-ordered, that we can’t use anywhere else in the hospital.’
Her solution? A virtual stock room. ‘Say I have to buy 50 wound bottles, but I only need 10. I’ll put the other 40 on this virtual stock room, and other wards can go “Hey, Kylie in ICU has got 40 wound bottles. I want them.” So they can go to that ward. And vice versa.’
Her prototype virtual stock room, sharing between theatre and the emergency department, has saved $8,000 since January. They’ve gone from 284 products a month to 52, and the cost has gone from $2,100 to $460.
‘Have I got rid of the problem? No. Have I reduced the problem considerably? Yes.’
How to make change
Anyone can make change, Kylie concluded. ‘I started as a very little fish in a very big pond, but I had a small idea that took off.’
Her key tips to successfully make change in your workplace include:
- Identify a problem and brainstorm a solution
- Create a business case (the new environmental sustainability standards will give weight to your arguments)
- Engage your stakeholders – especially infection prevention – early and often
- Use your usage reports to prove cost effectiveness
- Use your contacts, particularly procurement
- Use standard evaluation forms
- And if you’re looking to publish – ‘which you should be’ – contact ethics early.
[1] Eric Vozzola, Michael Overcash and Evan Griffing, ‘Environmental considerations in the selection of isolation gowns: A life cycle assessment of reusable and disposable alternatives’, the American Journal of Infection Control, August 2018
