Climate change has been described as ‘the biggest global health threat of the 21st century’.1 Medical professionals have a vital role in mitigating the impact of healthcare systems on the environment and protecting vulnerable people through the development of sustainable clinical practices. We have previously written about how gastroenterologists must act now to change our endoscopy practice and make it more aligned with core principles of environmentally sustainable healthcare. But it is clear there is a significant lack of evidence to accurately define the scope of the environmental impact of gastroenterology services, or models of best practice to shape policy and move the field in a new direction. This article aims to provide a framework for us to design and implement quality improvement projects (QIPs) in gastroenterology as a strategy to deliver a more sustainable future in line with the National Health Service (NHS) Net Zero targets.2 Mortimer et al have described the key principles required,3 4 and we aim to apply these to a gastroenterology context and specifically endoscopy services. The value of a healthcare intervention relates to the outcomes delivered against its cost, and the benchmark for cost-effectiveness set by the National Institute for Health and Care Excellence is £20–30 000 per quality-adjusted life year gained.5 However, economists interested in sustainability recognise that costs also need to recognise the social and environmental impact of what is consumed: the so-called ‘triple bottom line’.6 Value can thus be presented using this schematic formula as described by Mortimer et al 3: Value=outcomes for patients and populations/environmental+social+financial impacts. Considered in this way, every healthcare intervention has not only financial implications, but also a social cost on the patient and their family/carers, and environmental implications from resource use and carbon footprint, against which the clinical benefit needs …

中文翻译：

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绿色内窥镜：利用质量改进发展可持续实践

气候变化被描述为“21 世纪最大的全球健康威胁”。1 医疗专业人员在减轻医疗保健系统对环境的影响和通过发展可持续临床实践保护弱势群体方面发挥着至关重要的作用。我们之前曾写过胃肠病学家现在必须如何采取行动来改变我们的内窥镜检查实践，使其更符合环境可持续医疗保健的核心原则。但很明显，缺乏证据来准确定义胃肠病学服务的环境影响范围，或制定政策并将该领域推向新方向的最佳实践模型。本文旨在为我们设计和实施胃肠病学质量改进项目 (QIP) 提供一个框架，作为根据国家卫生服务 (NHS) 净零目标实现更可持续未来的战略。 2 Mortimer 等人已经描述所需的关键原则，3 4 我们旨在将这些原则应用于胃肠病学背景，特别是内窥镜检查服务。医疗保健干预的价值与其成本相关，国家健康与护理卓越研究所设定的成本效益基准是每获得质量调整生命年 20-30 000 英镑。 5 然而，经济学家对可持续性感兴趣的人认识到，成本还需要认识到消费的社会和环境影响：所谓的“三重底线”。6 因此，可以使用 Mortimer 等人 3 所述的示意图公式来表示价值：价值=患者和人群的结果/环境+社会+财务影响。以这种方式考虑，每项医疗保健干预不仅会产生财务影响，还会对患者及其家人/照顾者产生社会成本，以及资源使用和碳足迹对环境的影响，而临床效益需要...