Sustainability
Scotland by 20% by March 2026. If achieved, SSDs would see a reduction in energy consumption, water usage, and associated consumables, with initial estimates indicating a potential reduction in carbon emissions of over 400 tonnes. Additionally, this would provide SSDs with much needed relief by increasing their capacity across the system. Outcomes expected by surgical specialties auditing and streamlining surgical sets across NHS Scotland (summarised in Image 1) include:
lIncreased lifespan of instruments This will be achieved by removing unused instruments from surgical sets, reducing the number of times instruments are processed, hence, extending the lifespan of the instruments.5
lReduction in tray size By auditing and streamlining surgical sets this will create the conditions for clinical teams to reduce the size of their surgical trays, less instruments, requiring less space to store and process them.
lRecognition of more environmentally friendly practices Auditing instrument usage will identify instruments that may benefit from being migrated into standard sets as opposed to sitting as a supplementary item. In Rizan et al’s paper3
it was highlighted that supplementary
items were almost three times more carbon- intensive than items placed on a tray (0.145kg/ CO2e per instrument).
lIdentification of space to invest in reusable alternatives Creating space on surgical sets will allow
Table 1: Summary of the benefits of Lean Surgical Trays
conversations to take place with clinicians and the relevant stakeholders to investigate current single-use instruments to determine if there is merit in migrating certain instruments to reusable alternatives.
lReduction in musculoskeletal injuries Surgical sets place significant load on the SSD, portering and theatre staff who must transport, handle and manoeuvre these sets. A reduction in the volume and weight will reduce the risk of musculoskeletal injuries.
lImprovement in theatre efficiencies With fewer trays and instruments to count and check before, during and after surgery, theatre staff would spend less time on this task allowing for greater efficiencies peri-operatively.
Considerations It has been documented that in some theatre cases, across multiple surgical specialties, up to 75% of items on surgical trays may remain
unused.6 Research has shown that only 13-22%
of the instruments on standard surgical trays are utilised during procedures.7,8
This indicates
that SSDs are reprocessing significant amounts of surgical equipment that is never used, contributing to pressures within the service. It is important to address this by taking a clinically- led approach to identify waste and efficiencies. The concept of “leaning” a surgical tray
involves reducing the number of instruments on the tray, ensuring that this does not impact on patient care. Therefore, this process must be approached cautiously, systematically, and under the guidance of clinical teams. Efforts have previously been made to streamline surgical sets within NHS Scotland. These efforts to ‘lean’ surgical trays have been conducted on an ad hoc basis, with pockets of clinicians across the country rationalising the instruments they no longer require. This work has historically been difficult to implement due to the variety of stakeholders needed to consult and clinical time constraints. This has led to many surgical sets not being audited and historically used instruments remaining on the set. In an attempt to address this problem, the Orthopaedic Department of the NHS Golden Jubilee Hospital developed a methodology to demonstrate the approach required to streamline surgical sets. Their approach yielded positive results with the trial reducing the volume of instruments on their identified procedure set by 30% and the number of trays by 20%. The results of the pilot are available within the ‘Implementation of Lean Surgical Trays’ Opportunity for Change on the NGTP website.9 The success of the project inspired the National Green Theatres team to begin developing an implementation strategy that would be applicable to all surgical specialties across NHS Scotland.
Approach The NGTP established a multi-disciplinary project team to develop an implementation plan that would engage with key surgical specialties,
April 2025 I
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