Activism for health: green surgery

Dear Editor

Climate change represents a devastating threat to global health. [1] The main benefits of outreach clinics have previously been perceived to be patient convenience and resource efficiency. [2] We performed a study in the South of Ireland assessing the environmental benefit of dermatology outreach clinics from our regional centre of excellence in Cork to Bantry General Hospital (86.5km from Cork) and Kerry General Hospital in Tralee (112km from Cork). We aimed to calculate the reduction in carbon dioxide (CO2) emissions from outreach clinics in Tralee and Bantry, and to calculate the time saving for patients attending the clinics. 

A retrospective review was performed of all dermatology outreach clinics in Bantry General Hospital (BGH) and University Hospital Kerry (UHK) from January to June 2019. Patients’ addresses were obtained anonymously and input to three different mapping services (Google Maps, Apple Maps, and maps.me). The distance from the patient’s address to the outreach centre was subtracted from the distance from the patient’s address to the lead regional centre in Cork to calculate the distance saved per round trip. The reduction in CO2 emissions was calculated using an algorithm supplied by the Irish Environmental Protection Agency, subtracting the CO2 emissions of the doctors travelling to the clinics from Cork.

1,022 patients attended 44 outreach clinics in total. The data from BGH and UHK were combined and the consultant data were subtracted to calculate the overall saving. In total, there was a reduction of 144,789km of travelling (142km average per round trip), with 26.18 metric tonnes of CO2 saved. The average time saving was 129 minutes per round trip per patient. Extrapolating the results, the annual reduction in carbon emissions as a result of the outreach clinics is 52.37 tonnes.

Dermatology outreach clinics massively reduce our national carbon footprint, provide convenience to patients, and optimise access to dermatology services in rural areas. This model of care could be adopted by many specialties globally to optimise the sustainability of medical care.

Competing interests: None declared.

References
1. Gilding P. Why I welcome a climate emergency. Nature 2019;573:311. 10.1038/d41586-019-02735-w 31530929
2. Gruen RL, Weeramanthri TS, Knight SS, Bailie RS. Specialist outreach clinics in primary care and rural hospital settings.. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD003798. 10.1002/14651858.CD003798.pub2.