A sustainable clinical blood sample transport system

A sustainable clinical blood sample transport system

This project was completed as part of the 2025 Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH) Green Team Competition, implemented by the clinical science team.

Team members

Laura Cook, Clinical Scientist, Emma Miler, Clinical Scientist, Bitzy Cave, Biomedical Scientist, Emily Leach, Clinical Scientist George, Bailey, Pre-Analytics manager.

Setting / patient group:  

GP surgeries from North Norfolk and Norwich requiring potassium blood samples to be delivered to Eastern Pathology Alliance (EPA).

Issue:

During winter 2024/2025 five GP surgeries from the north Norfolk coast complained about a large number of raised potassium results.  This was thought to be due to potassium leaking out red blood cells when exposed to cold.  This risks misdiagnosis and repeat testing, resulting in delays to patient care and increased strain on the NHS.  There have also been patient complaints about unnecessary hospital trips due to incorrect results.  These samples are also packaged in single use plastic bags, disposed of in clinical waste streams.

Aims:

• To introduce a sustainable method of transporting blood samples from GP surgeries to the laboratory at the NNUH.

• To reduce the number of falsely raised potassium results observed in the colder months by introducing temperature monitoring during transportation.

Intervention:

An audit was completed to compare the number of raised potassium levels in 10 GP surgeries in different areas, in different months.  Courier routes have been adjusted to reduce transit time.

ILogger bags are durable, reusable insulated bags, designed to maintain and map temperatures (via battery).  The Trust has 40 of these, supplied free from their laboratory provider Abbott.   

The iLogger can be connected the laboratory IT system, to view transport times and temperature exposure when authorising abnormal potassium results.  Samples delayed or exposed to low temperatures could be automatically blocked from being reported, to prevent false results being released.  There is a one-off connection charge of £13,000.   A trial will be conducted with the GP surgeries on the north Norfolk coast.

Outcomes:

Clinical Outcomes

• During winter the rate of elevated potassium levels in five surgeries in north Norfolk was 9-10% (average 2-3%).  These patients were potentially required to unnecessarily attend A & E for further investigations (9-13 patients per month).

Population outcomes 

• Both changes would help with equity of care. Currently patients living furthest away are disadvantaged by being more likely to require a repeat blood test.

Environmental Outcomes 

• The emissions from 300,000 single use plastic bags and absorbent pads are 19,524 kgCO2e.  Replacing these with 40 iLogger bags could reduce emissions by 19,387 kgCO2e.

• The emissions from 40 iLogger bags lasting 5-years, with batteries changed yearly are 137 kgCO2e.

• Additional carbon savings can also be added from unnecessary A&E visits (386 kgCO2e annually), reduced repeat blood samples (164 kgCO2e annually) and disposal of single use plastic bags (not calculated).

• Total projected annual savings are 19,937 kgCO2e, equivalent to driving 58,655 miles in an average car. 

• The environmental impact of the software change was not calculated.

Financial Outcomes

• 300,000 single use plastic bags cost £20,000 annually. There is no cost for the 40 iLoggers already owned, battery costs are £73 annually.  Using the iLoggers would save £19,927 annually.

• Reduced A & E admissions would save £2,548 annually.

• Total projected annual savings £22,475.

• Financial saving from reduced staff time booking and processing tests (unverified).

• One off cost of £13,000 to connect the iLogger software to the laboratory IT. 

Social Outcomes

• Reduced unnecessary visits to A & E.

• Increased job satisfaction from reduced waste.

• Improved workflow and capacity from avoiding booking in repeated blood tests, phoning through results and not opening individual bags.

Key learning point 

• This project shows changing to iLogger bags from single use plastic bags to transport blood samples, reduces plastic waste disposal and shows significant carbon and cost savings. 

• Using temperature mapped bags, could reduce raised potassium results reported inappropriately in GP surgeries located furthest from the laboratory. This would ensure fair and equal access to healthcare for patients currently disadvantaged by living further away. 

• Conversations are still ongoing to identify if transport providers can take the iLogger bags. Funding for software costs is being investigated.