Smart Theatres - St Georges Hospital, London

This report was commissioned by the NHS England Future Connectivity Programme and produced in collaboration with St George’s University Hospitals NHS Foundation Trust. 

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The following report sets out how St George’s Hospital has implemented an innovative pilot for smart operating theatres. 

The trust

St George’s Hospital is a large teaching hospital in Tooting, in the London Borough of Wandsworth. It is one of the UK's largest teaching hospitals and one of the largest hospitals in Europe. It is run by the St George’s University Hospitals NHS Foundation Trust, serves a population of 1.3 million and employs over 9,000 staff.

The hospital has around 1,300 beds and provides general tertiary care such as accident and emergency, maternity services and care for older people and children, and also offers specialist care for more complex injuries and illnesses, including trauma, neurology, cardiac care, renal transplantation cancer care and stroke. It is also home to one of four major trauma centres and one of eight hyper-acute stroke units for London.

The challenge

Operating theatres are complex environments with sensitive requirements. Management of temperature, humidity, and air composition is critical in maintaining safety for patients during surgical procedures, to avoid risks such as hypothermia when temperatures are too cold or humidity impacting the effect of anaesthetics.

The challenges St George's faced included:

• very high energy usage, and lack of visibility of what was causing energy consumption in operating theatres, with a significant impact on carbon footprint and cost
• a need to measure the number and impact of estate related failures in operating theatres and understand how this impacted patients’ outcomes and experience 

Estates failures leading to theatre downtime are estimated to cost £730k per year in a major trauma centre in London, so there was a need to reduce failures to:

• save money by reducing wasted staffing costs, downstream costs and loss of revenue
• improve patient outcomes and reduce the number of cancelled surgeries
• increase efficiency and reduce waiting lists for operations

The solution

The St Georges Smart Theatres Project has converted operating theatres to be ‘smart’ by implementing real-time environmental monitoring. This was done by installing additional sensors which can measure CO₂ presence, air quality and energy consumption, then analyse and display this data alongside existing temperature and air change data gathered by the upgraded hospital building management system (BMS).  

This data is then used to:

• provide a dashboard overview of operating theatre conditions for staff and patients
• generate alerts if thresholds are breached (for example if temperatures are too high or low)
• present live energy usage data in individual theatres
• initiate a new 'automated set-back mode' - when theatres are not in use, power is turned off to reduce wasted energy use

The alerts generated with this data are predictive rather than reactive. They trigger the facilities management team to dispatch staff to resolve issues before they cause estates related failures to reduce the risk of downtime.

Phase one was rolled out after the successful implementation of two pilot operating theatres completed in January 2024. Phase two will implement the same approach in St George’s remaining 29 operating theatres.

The initial two theatre pilot was funded by an allocation of South West London Integrated Care Board's (ICB) green fund and St George’s capital investment. The roll out to the remaining 29 theatres is wholly funded by SW London ICB's 2024/5 green funding allocation. The trust were successful in a bid to the New Hospitals Programme (NHP) innovation fund to further develop smart theatres (phase 2) in October 2024.

See the full St George's Hospitals Smart Theatres Report on the FutureNHS collaboration platform for further detail and access to report appendices including:

• smart theatres business case
• project documentation and checklists
• list of technology and sensors used
• smart theatres carbon calculator
• independent review report
• connectivity flow chart
• reports and dashboard data