Potential carbon savings in the management of shoulder dislocations through allied health professional-led patient pathways: an observational study using audit data

Background Streamlined healthcare pathways can have advantages in terms of a more efficient service and better outcomes for patients, financial savings and lower carbon footprint. The aim of this study was to look at the potential carbon savings associated with streamlining clinical care pathways for people presenting to the emergency department (ED) with shoulder dislocation.

Methods This was a retrospective analysis of routinely collected clinical data for the purposes of quality improvement. Data were collected for randomly selected patients recorded as attending the ED of a major trauma centre in England with a shoulder dislocation between 1 April 2022 and 31 March 2023. Data were collected relating to demographics, presentation, treatment received, imaging, hospital attendance and secondary complications. Care activities associated with the current pathways were linked to carbon emissions factors to identify areas for action. Where they existed, mitigation actions were then identified, and potential carbon savings calculated.

Results Data were collected for 154 (88.5%) of 174 patients attending ED with a shoulder dislocation during the study period. raumatic dislocation without fracture patients dominated (68.2%). Across all dislocation types, 92 (59.7%) patients were aged 15–34 years and 109 (70.8%) were male. 13 specific actions that could result in carbon emissions reduction were identified. If these actions were implemented, we estimate that there is potential to save 86.4 kgCO2e per patient. For 2022/2023 across the whole of England (n=30 846 patients who presented to ED with a shoulder dislocation), we estimate that 2666 tonnes CO2e could be saved enough to power 2426 homes with electricity for 1 year.

Conclusions There is scope to substantially reduce the carbon footprint associated with ED attendances for shoulder dislocation. Efficient, streamlined pathways are needed if the National Health Service is to meet its commitment to net-zero carbon emissions by 2045.