Use of histopathology multiwell cassettes to reduce waste in endoscopy procedures

Project completed as part of the 2024 Hampshire Hospitals NHS Foundation Trust Green Team Competition.

Team members:

• Dr James Kinchen, Consultant Gastroenterologist
• Resmi Rajesh, Charge Nurse, Endoscopy Unit
• Edit Szabone Kalmar, cellular pathology operational manager

Setting / patent group:  

Basingstoke and North Hampshire Hospital Endoscopy Unit

Issue:

Where biopsies are taken during an endoscopy (> 50% of cases), the samples are currently placed in an individual pot containing a preservative solution, formalin. Each sample, including where multiple are taken from an individual patient, requires its own pot. These are then transported to a histopathology lab, where each is then put in a paraffin block that before processing for analysis.

‘Multiwell’ cassettes are also available, that allow for multiple samples to be stored in a single container. This reduces the use of plastic and resources both up and down stream. Less plastic storage is required during the endoscopy and biopsy, and fewer paraffin blocks and glass slides are required in histopathology. These benefits reduce environmental impact, financial cost, and reduce staff exposure to chemicals (fewer formalin pots required), and potentially reduce reporting time by increasing processing efficiency in the histopathology labs.

Intervention:

A Standard Operating Procedure (SOP) was developed from a previously trial using multiwell sample cassettes at Winchester Hospital. The team then engaged with cellular pathology and the wider endoscopy team to foster multidisciplinary working. This group collaborated to identify benefits and address challenges arising from changes to the biopsy protocol. For example, it was agreed to exclude cancer patients due to increased risk around sample contamination. Once the new protocol, including the use and consistent labelling of multiwell cassettes, has been finalised, it will be presented for clinical governance sign off, and it will be disseminated to staff, along with the new cassettes.

Outcomes:

• Environmental
  • Reducing use of single sample pots reduces emissions by 4277kg CO2, the equivalent to driving 12,602
• Social
  • Improved efficiency and productivity for pathology teams
  • Reduced anxiety for patients as they will have a shorter wait time for biopsy results
  • Reduced staff exposure and risk of chemical spills
• Clinical
  • Reduced reporting times reducing both patient anxiety and quickening a patients introduction to an appropriate treatment pathway
• Financial
  • The new protocol will save £2.50 per patient, saving £11,400 per year for the Basingstoke Site

Key learning point:

The key to progressing this project was the establishment of a multidisciplinary team including consultant, nursing, and laboratory staff. Also important was having a clear SOP and communicating the change clearly with all staff