Environmentally sustainable dermatology.

In 2017, health and social care organisations contributed 6.3% of carbon emissions in England. Efforts to reduce the environmental footprint of the NHS have been broadly focussed on reducing demand, through prevention and patient empowerment, and modifying supply side factors by focussing on lean care systems and low carbon alternatives. This narrative review is focussed on supply side factors to identify sustainable practices with a focus on actions that could be implemented in dermatology departments. A literature review was conducted In MEDLINE in April 2020. The search terms included 'environmental sustainability', 'climate change' with 'dermatology', 'telemedicine', 'NHS', 'surgery' and 'operating theatres'. Out of 95 results, 20 were deemed relevant to the review. Whilst there is clearly growing interest in environmental sustainability, 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. 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 organisations.

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