Bespoke Procedure Pack Transformation at United Lincolnshire Teaching Hospitals NHS Trust

Collaborative new processes are ensuring efficiency, driving savings and reducing waste at United Lincolnshire Teaching Hospitals NHS Trust (ULTH). Introduced by Kelly Marsh (Senior Lead Clinical Procurement Specialist at ULTH) and Sam Gray (Clinical Procurement Specialist at ULTH).

Comprising of four hospital sites – Lincoln County Hospital, Grantham and District Hospital, Pilgrim Hospital in Boston and County Hospital Louth – ULTH undertook a strategic initiative to streamline use of bespoke procedure packs.

These packs are traditionally customised sets of surgical consumable components used for surgical operating procedures, and they were originally designed for efficiency in clinical workflows. The original concept was to have bespoke packs for each operating procedure.

However, due to the differences between surgeons’ preference and requirements it became problematic to get the professionals to agree on each packs’ contents. These challenges meant pack components were discarded before use and additional components selected from the theatre stores.

Procedure packs are often used by NHS trusts to reduce waste, save time and provide the surgical teams with a ‘one stop pack’. ULTH challenged this assumption. After careful analysis it was concluded that the packs do not always work due to:

• Teams being unable to agree the contents.
• Packs often having missing components due to stock shortages from suppliers.
• Some components were also found separately on the shelves in theatre stores leading to unnecessary duplication of stock.

The key issue at ULTH was overstocking and the inclusion of unnecessary components in some of the packs, which resulted in increased clinical waste, higher procurement costs, doubling up of stock holding, or multiple consumables discarded before use. Storage of the packs was difficult due to the size and quantity required.

ULTH implemented a rationalisation strategy with a focus on:

• The removal of bespoke procedure packs.
• Retaining only core components essential to all procedures.
• Storing additional items within theatre stores for quick access.
• The creation of a minor and a major procedure pack that could be utilised for any procedure, the ‘Procedure starter pack’.

This hybrid approach maintained clinical flexibility while significantly reducing waste and creating more storage space within the main stores.

The ULTH Supply Chain teams supported the initiative by relocating storage areas closer to theatres and the re-allocation of stocked items within theatres for easy access.

The ULTH Supply Chain team worked closely with the Clinical Procurement Specialist team to streamline and transition from packs to individual components. Data was used to create standardised lists and stock levels to support the removal of procedure packs in a timely way to avoid any supply disruption.

1. Stakeholder collaboration and engagement
Initial resistance was overcome through decisive leadership, which was led and driven by the Clinical Procurement Specialist team. The trust made a firm decision to discontinue the purchase of bespoke packs, which prompted broader engagement (QIA board, centralised receipt and distribution, theatre stores and clinical procurement specialists).

2. Data analysis
Cost data and waste estimates were compiled based on the evidence about unused components alongside significant feedback from theatres. A detailed review identified commonly used items across procedures that enabled the introduction of a universal minor and major procedure pack.

3. Standardisation
Two universal packs were developed, one for minor procedures and one for major. These contained only essential items that could be used within any operating speciality as a ‘start up pack’. These packs are then complimented by off the shelf items, bespoke to the individual surgeon or procedure.

4. Implementation
The project was completed within five months, from decision to full rollout. Caesarean section (c section) and delivery packs remained unchanged due to their specific clinical requirements. The project was phased by site, starting with the centre of excellence for elective surgery first at Grantham and District Hospital to prove that the concept could work for all four sites.

The elective site was chosen first to reduce risk and to roll out the project in a safe and measured way. Phasing also allowed stock to be used up by sites that were yet to implement the new way of working. Any lessons learned from the rollout at the elective site could then be addressed before commencing the roll out at the more complex sites.

*The savings are projected to be in excess of £300,000 to be confirmed following full implementation at all four of the trust’s sites.

Clinical consumable waste is being reduced, along with improved resource utilisation. Significant storage space has been created for central stores at all sites.

There has also been a notable cultural shift – with surgeons and clinical teams demonstrating increased engagement and collaboration. Surgeons now have more choice and the ability to change requirements quicker.

Key benefits for the teams that we support include:

We are actively seeking other trusts who may be interested in adopting this standardisation approach. Please contact our procedure packs team or your ICS Manager.