Streamlining procedure packs

Project completed as part of the University Hospitals of Northampton Green Team Competition. 

Team members: 

Dr Slater, Consultant Anaesthetist, Dr Lyon, Clinical Fellow Anaesthetics/ITU

Setting / patent group: 

Critical Care and Anaesthetics

Issue:

Routine use of preassembled epidural, spinal and central venous catheter (CVC) packs at Northampton General Hospital was generating unnecessary clinical waste, cost and carbon emissions because many items were never or rarely used. Staff reported that pack contents did not reflect real practice, leading to frequent opening of additional items and the disposal of unused components. Additionally, several important safety related items were missing from the CVC pack, meaning clinicians had to source them separately and opportunities to reinforce best practice were being missed. 

Intervention: 

The team undertook a detailed review of the three custom-made packs used in anaesthetics and ITU, via clinician surveys that captured how often each component was used. Items consistently identified as unnecessary were proposed for removal, and essential components frequently opened separately, such as Tegaderm and Lock‑It Plus, were recommended for inclusion. Safety opportunities were addressed by adding a transducing line and blood gas syringe to the CVC pack, to support more reliable venous confirmation. Polyware trays were recommended to be replaced with more sustainable alternatives. 

Outcomes:

Clinical

No adverse outcomes were predicted from removing unused items, and the inclusion of a transducing line and blood gas syringe in the CVC pack, is expected to support safer practice. Removing gallipots from neuraxial packs reinforces best practice‑practice aseptic technique by reducing unnecessary handling steps when drawing up saline.

Environmental

Modelling showed that streamlining pack contents could save an estimated 948 kgCO₂e per year across epidural, spinal and CVC packs. These savings reflect reduced materials, manufacturing, transport and waste disposal requirements associated with unused components. This is the equivalent of driving 2,789 miles in an average car of unknow fuel.

Financial 

Direct pack price changes could not be estimated because suppliers did not confirm revised costs during the project window. A small saving from reduced waste disposal, amounting to £72 per year was identified. Minor time savings for staff through reduced need to collect supplementary items, were acknowledged but not quantified.

Social

Staff reported strong support for reducing unnecessary waste and aligning pack contents with real practice, and the project was viewed positively within the anaesthetic and ITU teams. Patients are unlikely to be aware of the changes, but there are opportunities to share sustainability improvements through QR codes and organisational sustainability communications.

Key learning point 

The project demonstrated the value of clinician driven reviews of preassembled procedure packs and highlighted how sustainability and patient safety can be advanced together. Early engagement with procurement and suppliers is essential, as modification of pack contents is constrained by manufacturers. 

Although implementation was delayed, the project established a clear, evidence‑based framework for future pack redesign, demonstrating how sustainability and patient safety can be advanced together. Early engagement with procurement and suppliers remains essential, as manufacturers ultimately control modifications to pack contents, and the project is currently awaiting confirmation from manufacturers regarding changes to pack pricing, before final agreement with procurement can be reached.