School of Medicine, Cardiff University, Cardiff, UK.
Department of Dermatology, University Hospital of Wales, Cardiff, UK.
Clin Exp Dermatol. 2021 Jul;46(5):807-813. doi: 10.1111/ced.14516. Epub 2021 Jan 12.
In 2017, health and social care organizations contributed 6.3% of carbon emissions in England. Efforts to reduce the environmental footprint of the National Health Service (NHS) have been broadly focused on reducing demand, through prevention and patient empowerment, and modifying supply side factors by focusing on lean care systems and low carbon alternatives. This narrative review concentrates on supply side factors to identify sustainable practices with a focus on actions that could be implemented in dermatology departments. For this study, a literature review was conducted In MEDLINE in April 2020. The search terms included 'environmental sustainability' and 'climate change' with 'dermatology', 'telemedicine', 'NHS', 'surgery' and 'operating theatres'. Out of 95 results, 20 were deemed relevant to the review. Although the review showed that there is clearly growing interest in environmental sustainability, the identified literature lacked examples of comprehensive implementation and evaluation of initiatives. The literature discussed distinct areas including transport, waste management and procurement as part of a lean healthcare system. A number of papers highlighted the potential contribution of carbon-reducing actions without citing verifiable outcome data. This narrative review highlights the need for detailed environmental impact assessments of treatment options in dermatology, in tandem with economic analysis. In conclusion, we have identified a clear need for evidence-based guidance setting out implementable actions with identifiable benefits achievable within local clinical teams. This will require engagement between clinicians, patients and healthcare organizations.
2017 年，英格兰的卫生和社会保健组织贡献了 6.3%的碳排放。为了减少国民保健制度（NHS）的环境足迹，人们广泛致力于通过预防和增强患者能力来减少需求，并通过关注精益护理系统和低碳替代品来调整供应方因素。本叙述性综述集中于供应方因素，以确定具有可持续性的实践，重点是皮肤科部门可以实施的行动。为了进行这项研究，我们于 2020 年 4 月在 MEDLINE 上进行了文献回顾。搜索词包括“环境可持续性”和“气候变化”，以及“皮肤科”、“远程医疗”、“NHS”、“手术”和“手术室”。在 95 项结果中，有 20 项被认为与综述相关。尽管该综述表明，人们对环境可持续性的兴趣明显增加，但所确定的文献缺乏对倡议的全面实施和评估的例子。文献讨论了包括交通、废物管理和采购在内的不同领域，作为精益医疗保健系统的一部分。一些论文强调了减少碳排放行动的潜在贡献，但没有引用可核实的结果数据。本叙述性综述强调了需要对皮肤科治疗方案进行详细的环境影响评估，同时进行经济分析。总之，我们发现明确需要有循证指导，列出可在当地临床团队中实施并可实现可识别效益的行动。这将需要临床医生、患者和医疗保健组织之间的参与。
