EDI&S SO08 A novel approach to environmentally sustainable surgical theatre by rationalising surgical instrument set – a qualitative analysis

Abstract

Abstract Background The surgical theatres are a major source of hospital waste generation. The NHS has set a net zero supply chain target by 2045. This aim is supported by the RCS intercollegiate green theatre checklist to reduce the environmental impact of operating theatres. One key area identified in this process, that will support the net-zero target is surgical instrument tray rationalisation. Laparoscopic cholecystectomy was identified as one of the most common surgical procedures performed in England. The purpose of this study was to demonstrate the impact of rationalising the number of surgical instruments, enabling surgeons to drive towards net zero surgery. Method Our Trust participated in this study, in collaboration with NHS England sustainable procurement team and the innovation agency. Total 58 cholecystectomies performed across two sites, Pinderfields and Dewsbury were included in this prospective audit undertaken from January – March 2023. The surgical tray checklists were used to record the actual instrument usage and noted the redundant and supplementary instruments. This data presented to a surgical advisory group, who agreed on routine instruments and proposed removal of redundant. A green pilot tray was approved and used for cholecystectomy. Qualitative questionnaire feedback was collected from surgeons and operation theatre staff from both sites. Results The instrument use matrix revealed almost 50% instruments from the previously used major tray were never used in any of the 58 cholecystectomy surgeries performed. Subsequently, based on the use matrix data, we switched from using major tray containing 84 instruments, to a reduced size tray containing 46 instruments including re-usable metal ports. Survey results revealed tray rationalisation led to easier and faster surgery preparation, improved efficiency and a reduction in waste, thereby reducing the cost to the Trust. It was also noted that having a smaller tray means less time to count instruments during the surgical pause. Conclusion The results of tray rationalisation are very positive and have demonstrated cost savings, carbon reduction and time saved preparing for surgery and the post-operative instrument count. This pilot study has shown that by making the surgical set smaller, savings have been achieved from a reduction of slots required per machine cycle for decontamination. Tray rationalisation goes some way towards the net goal of zero carbon surgery and delivering a sustainable future.