a greener approach to skin grafting A Royal North Shore Hospital initiative is reducing carbon emissions from eligible skin grafting procedures by 73 per cent, while helping patients with small burns receive treatment sooner. The No GA, No Delay: Skin Grafting the Local Way project allows suitable patients to undergo skin grafting under local anaesthetic in the Severe Burns Injury Unit Ambulatory Care Clinic, rather than in an operating theatre under general anaesthetic.
choose this pathway again. Procedures can be completed in less than two hours, allowing patients to remain awake and return home sooner to recover compared to having a procedure done through an operating theatre pathway. Clinical outcomes were comparable with the operating theatre pathway, with the same median graft healing time of 10 days and no unplanned admissions, regrafting or emergency department presentations recorded. RNSH specialist burns surgeon Dr Aruna Wijewardena said the pathway showed that more sustainable care could also improve the patient experience. “Patients have told us they are comfortable having the procedure under local anaesthetic, and importantly, we are achieving the same healing outcomes as the traditional theatre pathway,” he said. “By delivering this care in the clinic, we can treat patients while reducing emissions, avoiding hospital admissions and freeing up valuable theatre and inpatient resources.” The initiative is expected to avoid around 70 hospital admissions each year and deliver almost $382,000 in savings for Northern Sydney Local Health District. It will also support the district’s broader sustainability goals, including achieving net zero emissions by 2035 for emissions within its control and reducing the emissions it can influence by 50 per cent.
By moving appropriate procedures out of theatre, the pathway reduces the environmental impact associated with operating theatre resources, general anaesthetic, inpatient beds and larger clinical teams giving more opportunities to the major burn surgeries. Led by Dr Aruna Wijewardena, Dr Nadya Rykina-Tameeva, transitional nurse practitioner Jessica Hew and Dr Rowan Gillies, the project won the Environmental Sustainability category at the NSLHD 2026 Quality and Improvement Awards and has also been nominated for a 2026 NSW Health Award in the Environmental Sustainability category. The project also received a $47,000 grant through the 2026 NSLHD Innovation Pitch Program to support its expansion and help educate other burn services across Australia about the pathway. For patients, the change means avoiding the preparation associated with a general anaesthetic and a shorter hospital stay with 100 per cent of patients saying they would
Shir (L-R) Transitional nurse practitioner Jessica Hew, burns (L-R) Transitional nurse practitioner Jessica Hew, burns surgeon Dr Aruna Wijewardena and resident medical officer Dr Nadya Rykina-Tameeva
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