Setting the digital agenda
A pioneering initiative at two operating theatres in St George’s Hospital, South London, aimed to cut energy consumption and carbon emissions, but is also demonstrating a range of benefits to staff and patients – and significant savings…
With multiple pressures facing the NHS – including the need to reduce waiting lists, save money and cut carbon emissions in line with the targets set for a net zero NHS1 – technological initiatives that address multiple issues at once are potential gamechangers. A pilot scheme at St George’s Hospital in South London is ticking all the boxes.
In January 2023, the hospital’s estates department began working with the New Hospitals Programme (NHP) and health-tech innovation company SRO Innovate (as part of the Academic Industry Partnership (AiP), which contains over 20 partner groups) to identify a project that would be appropriate to a digital environment and programme of work. The result was the SMART Theatres pilot – a project focused on two of the hospital’s operating theatres, with the aim of saving energy consumption and therefore carbon emissions by capturing and curating data using integrated technology such as sensors, and maximising existing data from the incumbent building management system.
“As reduction in energy consumption was the primary objective, we chose operating theatres because they’re the most energy-hungry part of a hospital generating high carbon emissions – one operation emits the same amount as driving a petrol car 450 miles,” explains David Roskams, Programme Director, Transforming Professional Services, Estates and Facilities at St George’s Hospital. The programme was aligned with the Intercollegiate Green Theatre Checklist2, and on the premise that the pilot would save both energy and carbon, St George’s received £60,000 from the South West London Integrated Care Scheme (SWL ICS) green capital fund3, which was supplemented with an additional £40,000 of funding from its ‘business as usual’ capital allocation.
Rooted in collaboration
From the start, the project involved not only clinicians and estates staff but also external partners. “We’re working with an ecosystem of industrial subject matter expert [SME] partners able to adhere to ‘key principles’, such as interoperability using open standards and client-owned data,” says Karl Redmond, Strategic Estates Lead at NHSE, Digital Smart Building Secondment to NHP and ICS Estates and Infrastructure Guidance. “These principles, as well as results supporting the project objectives, are controlled and validated by academia, led by Loughborough University and other universities. We took an ‘action research’ approach – which means we have a timetable, budget and target. The industry SMEs deliver and the academics control and validate.” The academics are completely independent and have approved every aspect of the project, from the estimates of savings to the methodology. “Everything that contributes to the project goes through review, scrutiny, approval and endorsement, which sanity-checks what we’re doing and ensures it’s robust and scalable,” states David.
“We begin in two operating theatres but it’s scalable to other parts of a hospital and the wider NHS,” continues Karl. “The approach follows a ‘Think Big, Start Small, Scale Fast’ method, which gives Trusts and the wider NHP and NHS the opportunity to carefully assess and manage implementation. That’s essential for a project that simultaneously takes on clinical, digital, estates, sustainability, finance and more.”
The SMART Theatres pilot is ambitious, yet the technology is straightforward and already in widespread use. “We’ve used lots of sensor technology and upgraded our building management system (BMS) to give us enhanced data and the ability to monitor performance and automate all the associated processes – such as controlling temperature, or triggering events if data thresholds are breached,” outlines David. “It’s also non-intrusive – it’s not about pulling apart the theatre, it’s about adding complementary technology and maximising and augmenting data from the BMS.” Importantly, the approach can be applied to both new builds (NHP) as proven best practice from the retrofitted theatres, and legacy estates.
In detail
The team started by automating the utilisation of energy in the two pilot theatres. “The Intercollegiate Green Theatre Checklist recommends powering off when the theatre isn’t in use,” says David. “This doesn’t happen in most theatres – the lights are often left on, for example, so the theatre uses energy 24 hours a day, even when it’s empty.”
Mark Mercer, Lead Programme Manager for SRO Innovate, explains that the smart theatres automatically shut down when unoccupied. “Sensors count the number of times the door opens and closes and monitor movement and the number of people in a room. After 15 minutes of detecting no movement or people, specific assets and systems are powered down or put on standby automatically.” Smart sockets gather data about the energy consumption of different assets – basically tracking energy consumption live at source. Most importantly, monitoring of the operating theatres – such as air quality, humidity and temperature – ensures the theatres remain in an acceptable condition during working hours and out of hours.
The theatres now look very different from the typical operating theatre, with two 55-inch monitors showing live theatre conditions for the first time through different lenses – for example, the estates and facilities management (E&FM) and sustainability teams can look at factors such as energy consumption, while clinical teams can check that the status of the theatre is optimal and compliant for the particular operation they’re carrying out. Events can be triggered to inform the E&FM team when operating theatres are sub-optimal, for example, change filters if air quality is becoming progressively poorer. “The thresholds have been set by guidance and approved by the clinical reference group for different operations,” says David.
Little to no staff training is needed, says Mark. “There’s a simple touchscreen dashboard for surgeons to check the theatre status settings. It’s very intuitive. If the indicators on the dashboard are green, the surgeon is reassured that the theatre’s conditions are within acceptable limits. If any indicators are amber or red, they know that a member of the E&FM team has been made aware and will intervene accordingly, speeding up the decision-making process and improving theatre availability and compliance.” This approach supports another of the Green Theatre Checklist recommendations: to intervene and fix in a timely manner with proactive maintenance techniques, which will result in a reduction in clinical downtime due to estates-related failures within the smart theatres.
The team has created a 3D model of the pilot smart theatres, facilitating asset location through wayfinding, and displaying real-time asset performance data using technology that highlights and names assets on the 3D model, displaying their sensor data. “This technology allows an E&FM team member to walk into a theatre and click on an asset to understand what it is, what it does, when it needs a service and how it’s performing,” summarises Mark. “For example, the E&FM technician can see if there are any outstanding work orders in the theatre and see the details of assets or tasks that need completing. The process can be fully automated, where an event is generated based on data showing the asset’s condition is out of its threshold. For example, if a device’s energy consumption increased by a certain percentage, a possible problem would be reported.”
Saving time and money
As the academia-verified indicative savings predicted, the pilot has demonstrated significant savings on energy – extrapolated to £500,000 once rolled out to all the hospital’s 31 theatres. “It has a return on investment (ROI) of 18 months based on energy savings alone – compared with a minimum ROI of five years in the NHS, often much longer,” says David. In addition to energy savings, there is the opportunity to make savings in other areas, too. The ability to efficiently control the theatre environment – ensuring it’s the right temperature and within air quality guidelines, for example. These types of improvement will, over time, result in a reduction in infection rates, and in delays and cancellations of operations. And that’s crucial, says David: “A two-year audit by an orthopaedic surgeon at St George’s found there were some 2,000 estates-related failures in the operating theatres over two years. With 31 theatres, this amounts to three or four failures every day. Reducing these failures will result in forecast efficiency savings of £730,000 per year across our 31 theatres. And that in turn improves the productivity of E&FM team, with a projected saving of £230,000 per annum.”
Savings aside, reducing basic estate faults in theatres has other benefits for patients and staff. “Unnecessary delays due to estates failures are stressful and disruptive for patients, who may have taken time out of their lives and gone without food to prepare for an operation, only for it to be cancelled at the last minute simply because the ventilation in the theatre isn’t working properly,” points out David. “Delays to care can also present risks to health, and they’re very frustrating for clinical staff, who may have to overrun to compensate – while the E&FM team are constantly on the back foot, reacting to problems. Reducing estates failures in theatres can ease the pressure in so many ways.”
Scaling up
Over time, the process will become ever more efficient. “The intent as we roll out is to develop AI around the theatre environment and equipment,” says David. “As we build our data warehouse for our smart theatres and for others, we’ll be able to reduce failures in the theatre environment and across the wider estate. We’ll know when something is going to go wrong and fix it before it goes wrong – the E&FM team will be alerted and will address it in a timely manner, potentially overnight, as opposed to the more reactive approach we have now which can result in downtime in the operating theatres and consequent cancellations and delays to the operating list.”
The team is also creating a ‘digital twin’ – a virtual theatre simulating the equipment and how it performs over time, so hospitals can predict even more precisely when something is likely to fail, long before it actually does. It will become more accurate as more Trusts come on board and feed in their data.
“The long-term vision is for consistent data from multiple Trusts to feed a central repository, and the more hospitals that participate, the more data we have to determine more precise insights and best practice,” says Mark.
Once a central repository has been created for theatres, it can be grown to other parts of the hospital. “In a similar way, we’ll be building the data warehouse with information from the wards, day surgery and so on,” says David. The NHS’s data ownership – separating the data from the respective platforms and providing access free of charge to legitimate users – is one of the factors that makes the project unique, argues Karl. “We will own the data, so we can move away from those disjointed systems that have created data silos. Instead, we work to an agreed method and a set of key principles, including interoperability and scalability – something that even the World Health Organisation (WHO) has recognised as a ‘unique approach’.”
The pilot results have led to St George’s being given all the SWL ICS ‘green funding’ in December 2023 to roll out the scheme to its remaining 29 theatres, which will be completed by the end of August 2024. “It’s already saving money and providing benefits in numerous ways, and this is just one project,” says Karl. “We want to repeat and scale this approach as fast as possible to other Trusts and projects. The application and adherence to the approach and key principles is critical – both will require a shift in thinking and culture in the NHS, NHP, and Trusts, as well as the market. Trusts are willing to adapt due to the growing pressures they face on a day-to-day basis, and that’s vital.”
Other innovations
Taking paper out of pathology
In 2023, North West Anglia NHS Foundation Trust launched its state-of-the-art Laboratory Information Management System, fully integrating the pathology services at Peterborough City and Hinchingbrooke Hospitals. With a £6.4m investment, the upgraded digital service reduces reliance on paper. It seamlessly delivers blood test results to GPs and patients – future-proofing the pathology service by enabling other digital improvement initiatives, such as bedside label printing for samples.
Smart partnership
In 2022, Manchester University NHS Foundation Trust (MFT) became a member of the Smart Hospital Alliance (SHA), propelling the adoption of advanced digital health technologies to elevate patient and community care. Leveraging the potential of mixed reality, augmented intelligence, and sophisticated data technologies, MFT is at the forefront of transforming healthcare service, enabling a more empowered experience for patients, the community, and healthcare professionals.
FOOTNOTES
1 https://www.england.nhs.uk/greenernhs/a-net-zero-nhs/]
2 https://publishing.rcseng.ac.uk/doi/10.1308/rcsbull.2023.25]
3 https://www.southwestlondonics.org.uk/our-work/investment-fund/]
To find out how your Trust can get involved, email karl.redmond@nhs.net
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This article was taken from the May 2024 edition of FORTIS magazine.
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