Quantifying the environmental and economic impact of telephone follow-up in hand surgery: A single surgeon's experience.

Introduction: The National Health Service (NHS) in England generates approximately 24.9 million tonnes of carbon dioxide annually. Achieving net-zero emissions requires contributions from all clinical specialties. Orthopaedics, as a high-emission specialty, has a critical role to play in this transition. The COVID-19 pandemic catalysed the widespread adoption of telephone consultations, which have demonstrated patient satisfaction, favourable clinical outcomes, and potential environmental benefits. This study evaluated the environmental and economic impact of a single surgeon's shift to telephone follow-up appointments. Materials and methods: Patients who received telephone follow-up consultations between March 2020 and March 2023 in one surgeon's clinic were retrospectively identified. Case notes were reviewed to determine diagnosis, treatment type, and need for further in-person follow-up. Travel distances were estimated based on patient addresses, and deprivation scores were calculated using postcode-linked indices. Results: A total of 118 telephone consultations were identified; six patients were excluded due to missing address data. Of the remaining 112, 37.5 % had carpal tunnel syndrome, 62 % followed surgical intervention, and 25 % followed injection. Secondary in-person follow-up was required in 26 % of cases, with no significant difference between postoperative and post-injection patients (p = 0.59). The intervention resulted in an estimated 1284 miles of travel avoided and a saving of 0.33 tonnes of CO Discussion: This study demonstrates that even a modest change in outpatient follow-up practices by a single clinician can yield measurable environmental benefits. Savings in patient expenses were found, particularly among those from disadvantaged backgrounds. If implemented across the NHS, such changes have the potential to significantly reduce emissions without compromising patient care and reduce direct costs to patients.