What your department can actually cut.
Not another campaign. A ledger of actions — each with its evidence grade, its CO₂e saving, and the study it comes from. Built for clinicians with a waiting list, not a communications budget.
Start where you stand.
The ledger is organised the way hospitals actually are — by specialty. Each department page lists its actions, grades and sources.
Operating theatres
The single most carbon-dense room in the hospital: gases, single-use instruments, ventilation running to empty rooms.
NEKidney care
Dialysis is resource-intensive by design — water, power, consumables, transport.
6 ACTIONS
RXInhalers & respiratory
MDI propellants are the biggest slice of primary-care prescribing emissions.
5 ACTIONS
GPPrimary care
Prescribing, patient travel, practice buildings — the front door of the system.
7 ACTIONS
MHMental health
Community visits, estate use and the least-audited corners of the system.
4 ACTIONSFive entries, the way the full ledger reads.
Printed on white because it's meant to be printed — pinned to a theatre noticeboard, taken to a governance meeting.
| ID | Action | Evidence | CO₂e / yr | Dept |
|---|---|---|---|---|
| ACT-011 | Switch desflurane → sevoflurane across elective lists | Strong RCT / dept data | 188 t | theatres |
| ACT-014 | Plug-and-test manifold leaks; fix N₂O piping at source | Strong RCT / dept data | varies | theatres |
| ACT-021 | Dialysate flow reduction where clinically appropriate | Cohort / modelling | 12 t | kidney care |
| ACT-031 | Dry-powder inhaler switch for eligible asthma patients | Strong RCT / dept data | 146 t | inhalers |
| ACT-041 | Single use of plasma-derived waste streams audit | Estimated | est. | primary care |
Two charts that explain the whole ledger.
Every action on this site sits under these two distributions. Sources on each chart.
Audit-grade, not advice-column.
Pick an action
Filter your department's ledger by evidence grade and effort. Every entry names the study behind the number.
Measure your baseline
Gas logs, inhaler prescribing data, dialysate volumes. Each action page lists the exact dataset to pull.
Log the delta
Report the change in the same units the ledger uses — so your number adds to a public, comparable record.
What the literature measured this year.
Continuously scanned from Europe PMC. Full timeline with grades on the evidence page.
Environmental sustainability in anesthesia and operating room practice
BMC Anesthesiology 2026 · DOI 10.1186/s12871-026-03858-0
Green nephrology: mitigating the environmental burden of dialysis
Frontiers in Medicine 2026 · DOI 10.3389/fmed.2026.1793544
Effects of departmental green anaesthesia interventions on carbon emissions
British Journal of Anaesthesia 2025 · DOI 10.1016/j.bja.2025.03.038
CO₂e emissions and cost impact of inhaler switching programmes
Current Medical Research and Opinion 2026 · DOI 10.1080/03007995.2026.2628120
Asked by clinical teams.
Where do the CO₂e numbers come from?
SOURCES: EUROPE PMC · NHS ENGLAND
Can I use the ledger in a QI project?
SUSQI FRAMEWORK · CSH
Is this the old Centre for Sustainable Healthcare site?
DOMAIN HISTORY · WAYBACK MACHINE
Three rules, no exceptions.
No number without a source
Every CO₂e figure and every grade links to a named study, guideline or NHS publication. No entry ships on vibes.
Grades travel with claims
An action is only as strong as its evidence. Grade A through C is printed beside every claim, on every page.
Clinical care comes first
Nothing here compromises patient safety. Where an action needs clinical judgement, the entry says so explicitly.
Three ways in.
Ledger updates
One email when entries change grade or new studies land. No campaign mail.
General contact: contact@greenerhealthcare.org — corrections, data submissions, reuse questions. One address, read daily.