A mixed-methods analysis of the climate impact, acceptability, feasibility and cost of switching from single-use pulp to reusable plastic trays in a large NHS trust.

A large, multi-site NHS trust piloted switching from single-use pulp to reusable plastic trays for use in clinical care. This mixed-methods analysis combines quantitative cost-effectiveness and greenhouse gas (GHG) emissions calculations with a stakeholder analysis and user survey to not only ascertain the cost and climate implications of this intervention, but to also better understand the use of trays across the trust to improve staff buy-in and, ultimately, the feasibility and success of the policy. We show that the plastic trays are both more cost-effective and climate friendly compared with the pulp trays, even using an annual replacement rate of 50% (higher than our anticipated rate of 5%), and that staff and key stakeholders would support the policy. Our analysis is one example of a larger trend in the return to reusable items, as awareness grows of the significant GHG emissions and waste produced from disposable, single-use items in healthcare.

Inpatient COVID-19 vaccination rollout: Improving access to vaccination.

BACKGROUND: We were aware of high numbers of inpatients unvaccinated against COVID-19 at Guy's and St Thomas' NHS Foundation Trust (GSTT). Due to this, an inpatient vaccination protocol was set up in July 2021, with initially limited uptake. METHODS: From October 2021, a multidisciplinary team worked to improve the protocol for inpatient vaccination, with the development of a system that gave ownership to clinical teams. RESULTS: In 4 months (July 2021 to November 2021), 20 inpatients had been vaccinated at GSTT. Following our intervention, rates of uptake increased, and 34 patients were vaccinated in less than 2 months (November 2021 to January 2022). Forty-five patients who had been referred were discharged without vaccination; attempts were made to invite them to receive a vaccine. CONCLUSION: An improved pathway and referral process increased the number of inpatient vaccinations delivered. Further work is required in order to ensure that more patients who have been referred are vaccinated.

Reducing Allogenic Blood Transfusion in Pediatric Scoliosis Surgery:: Reporting 15 Years of a Multidisciplinary, Evidence-Based Quality Improvement Project.

STUDY DESIGN: Retrospective review of prospectively collected spinal surgery and transfusion databases. OBJECTIVES: To evaluate the efficacy of a care pathway developed at our institution since 2003 with a focus on reducing the need for blood transfusions in children undergoing scoliosis correction surgery. The care pathway includes nurse-led clinics facilitating preoperative hemoglobin optimization, intraoperative cell salvage, the use of tranexamic acid, and a transfusion criteria awareness program. METHODS: Retrospective review of our institution's prospectively recorded spinal surgery and transfusion databases including all cases of scoliosis surgery in patients 18 years and younger between 2001 and 2015. RESULTS: A total of 1039 procedures were included in the analysis. Overall, 24.4% of patients received a transfusion. The proportion of patients transfused was 89.2% in 2001-2003, 39.6% in 2004-2006, 16.5% in 2007-2009, 15.6% in 2010-2012, and 20.1% in 2013-2015. The volume of blood products transfused in those undergoing transfusion was 9.1 units in 2001-2003, 4.8 units in 2004-2006, 5.0 units in 2007-2009, 2.3 units in 2010-2012, and 2.1 units in 2013-2015. A multivariate logistic regression demonstrated adjusted odds ratios for the probability of receiving any transfusion of 5.45 (95% confidence interval 3.62-8.11) for patients with neuromuscular diagnoses and 11.17 (5.02-24.86) for those undergoing combined anterior and posterior surgical approach. CONCLUSIONS: We have demonstrated over a 15-year period that the introduction of a multifaceted, multidisciplinary pathway can dramatically and sustainably reduce the need for blood transfusions and their attendant risks in pediatric scoliosis surgery. This data lends weight to the adoption of such a care pathway in pediatric scoliosis surgery.