Project Volatile – a regional quality improvement collaboration in the South West of England

Background: Sustainable Anaesthesia Peninsula (SAP) is a trainee-led collaboration focused on the environmental impacts of anaesthetic practice across the South West of England. ‘Project Volatile’ is a six-site service evaluation and quality improvement project aiming to assess and optimise volatile anaesthetic consumption. Methods: We recorded monthly volumes of volatile anaesthetic purchased at each site between January 2020 and December 2021. Volumes were converted to an equivalent in kilograms of carbon dioxide release (kg CO2e).1 Total hours of anaesthetic time were recorded at each site as a denominator, allowing us to account for variation in the volumes of surgical activity undertaken. We charted kg CO2e against hours of anaesthetic time across all sites each month (kg CO2e h–1), with a lower value representing a ‘greener anaesthetic’. Regular virtual meetings enabled collaborative sharing of existing best practices and effective interventions, such as local and regional educational presentations, ‘green’ theatre information boards, and removal of desflurane from anaesthetic machines. Results: SAP has demonstrated an online collaboration of enthusiastic trainees can facilitate data collection, promote change ideas, and deliver improvement across a wide geographical region. Our Statistical Process Control chart demonstrated sustained change indicating a statistically significant reduction in kg CO2e h–1 across the Peninsula. We hope this suggests clinicians are more carefully considering the environmental impact of providing anaesthesia, and that at times of clinical equipoise ‘greener techniques’ are being chosen. Figure 14 demonstrates the baseline monthly kg CO2e h–1 being consistently >2 before the formation of SAP and initiation of ‘Project Volatile’ in November 2020. In the latter 9 months of 2021, there has been a sustained reduction in monthly kg CO2e h–1 attributable to volatile anaesthesia, suggesting that either usage of volatile anaesthesia has reduced, has become more efficient, or both. Thanks to the many individuals across Peninsula, and to #PlotTheDots for the SPC Tools.