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GreenED is a Royal College of Emergency Medicine (RCEM)-led initiative to create, test and disseminate a framework of standards that drive operational sustainability in emergency medicine (EM). 

What is GreenED?

GreenED is a Royal College of Emergency Medicine (RCEM)-led initiative to create, test and disseminate a framework of standards that drive operational sustainability in emergency medicine (EM).

Developed by the RCEM Environmental Specialist Interest Group (ESIG), GreenED is unique in being the first grassroots-led sustainability framework in the NHS, empowering EM staff to take ownership and initiate change at a shop-floor level. The user-friendly GreenED framework contains immediate (bronze), medium (silver) and long term (gold) actions EM staff can take to integrate environmental sustainability into everyday practice, gives the means to evaluate the impact of those actions, and feeds into wider sustainability targets at both Trust and a national level. Interventions maintain or improve patient care and may also lead to financial savings.|

GreenED Framework

Ultimately we envisage GreenED evolving to a fully integrated package, including administration, database and technological support and with recognised accreditation for achieving the framework criteria.

Emergency Departments are a resource-heavy frontline NHS service. Through GreenED, we anticipate our speciality will be well-placed to make a significant contribution to NHS England’s world-leading strategy to deliver a ‘Net Zero’ NHS by 2040.

Progress to date

GreenED completed a 6-month pilot phase in eight Emergency Departments in May 2022. Initial analysis suggests savings of 153.7 tCO2e and £40,000. The final analysis and recommendations for improvement are due Sept 2022.

Thanks to the pilot sites at North Tees & Hartlepool NHS Trust, Kings College Hospital, Royal Preston Hospital, Royal Devon & Exeter, Brighton & Sussex Hospital, North Bristol NHS Trust, Oxford University Hospital and University College Hospital.

The EMJ Supplement carried a GreenED update in August 2022.

Want to get involved?

Join our mailing list for GreenED updates and information on how to sign up to the next phase of the GreenED rollout.

Follow us on Twitter @GreenED_uk for more updates and details of other ESIG workstreams.

Join us on our RCEM Study Day. Save the date – 6th June 2023. Registration via RCEM Events available soon.

Take action. The open access resources below provide tips and guidelines to start making sustainable changes in your Emergency Department.

Share your achievements with GreenED. If you have successfully introduced sustainable changes or run a sustainable QIP in your ED, we would like to showcase and share it with the EM community. Email us at

GreenED Open Access Resources

Start a Green Group 
The GreenED pilot identified making a multi-disciplinary “Green group” as a key initial step for introducing sustainable, lasting change into an ED.

How to set up a green group

Personal actions
Individual change improves personal health and carbon footprint, models sustainable action, confers authenticity, and inspires change in others. High impact personal changes include:

  • Transport choices – active or public transport over private car ownership
  • Dietary choices – reducing or removing meat or diary
  • Advocacy – considering the sustainable in all aspects of clinical work including quality improvement, clinical pathway development, and equipment choice.
  • Support Environmental Awareness days within your personal and professional life. The GreenED twitter account @GreenED_uk and ESIG newsletter carry regular updates about these.

Sustainable projects for the ED

Sustainable Project Proposals from St Thomas’ Hospital

Sustainable Project Proposals from the Royal Free, London

No to Nitrous from Royal Devon & Exeter

Nitrous Oxide & Pre-Hospital Emergency Medicine

Reducing cannulation in the ED – a CSH case study

Explaining Climate Science

Hugh Montgomery (Intensive Care Society Sustainability Lectures, 2021)

The Lancet Countdown report on health and climate change 2021

RCEM declares a Climate Emergency

In 2019 RCEM declared a Climate Emergency stating, “our expertise is in recognising, prioritising and treating emergency conditions. We recognise that climate change is a healthcare emergency and needs urgent treatment to ensure the continued wellbeing of the whole global community.” At that time RCEM created the ESIG to guide the College and speciality in becoming more environmentally sustainable whilst maintaining excellent practice, set a goal of carbon neutrality by 2040 and financially divested from fossil fuels.

GreenED is the flagship project of the RCEM Environmental Specialist Interest Group (ESIG). Alongside GreenED, ESIG and RCEM are developing other sustainable workstreams.

  • Raising awareness of the climate emergency and the role of healthcare
  • Improved education and advocacy at all levels of training and healthcare delivery
  • Evolving organisational operations to divest from fossil fuels, improve internal working practices and embed sustainability into leadership and decision making
  • Developing practical tools including calculators for carbon footprinting in EM
  • Re-imagining quality improvement to become sustainable quality improvement

In 2022 RCEM participated in the Climate Change and Health Scorecard review, demonstrating positive climate action alongside opportunities for further growth.

Climate Change & Health Scorecard Results

Education & Advocacy

RCEMLearning Climate Crisis Blogs – Air pollution

Centre for Sustainable Healthcare – GreenED network

Sustainable QI
ESIG and the RCEM Quality Assurance & Improvement committee are working closely together to develop systems of care that are sustainable for the planet and population. Representation from ESIG will integrate environmental objectives into individual quality improvement projects (QIPs) and the programme overall. Recognising that the GreenED programme is being piloted across multiple UK emergency departments, efforts will be made to ensure relevant QIPs developed by this committee align with the GreenED framework.

We will also work towards the development of a sustainability-focused national QIP with a primary focus on the environmental implications of healthcare delivery, as opposed to a QIP with a focus on patient-focused outcomes (see “spectrum of Green QIP” figure below), with ESIG leading the topic and providing oversight.

Spectrum of Green

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