Reducing unnecessary instruments in surgical tray sets could unlock significant financial and environmental benefits for the NHS, new GIRFT supported research has found, highlighting a practical opportunity to support both elective recovery and net zero ambitions.
With an estimated 313 million surgical procedures carried out globally each year, even small inefficiencies in how care is delivered can scale into substantial cost and carbon impacts. One such inefficiency is the routine inclusion of rarely used instruments in surgical tray sets, increasing reprocessing requirements, resource use and waste.
A study led by Prakriti Shrestha, a GIRFT clinical fellow at Manchester University NHS Foundation Trust (MFT), has explored how rationalising surgical trays can address this challenge. The research, published in the World Journal of Surgery, examined the impact of optimising general surgery tray sets at the Trafford Elective Surgical Hub in Manchester.
This work reflects GIRFT’s wider focus on delivering high-quality, sustainable care through its net zero and sustainability work and its commitment to developing future clinical leaders through the Clinical Fellowship Programme.
The study analysed a clinical quality improvement project, reviewing instrument usage in real-world practice and working with clinical and operational teams to design optimised tray configurations.
Building on earlier pilot work at Leeds Teaching Hospitals NHS Trust, the study focused on four high-volume procedures carried out at the Trafford hub: open hernia repair, rectal procedures, laparoscopic hernia repair and laparoscopic cholecystectomy.
Rationalisation led to substantial reductions in the number of instruments per tray. For example, trays used for rectal procedures were reduced from 53 instruments to just 16, with reductions also achieved across small basic, large basic and laparoscopic trays.
These changes delivered estimated annual savings of £16,863, demonstrating the immediate financial benefit of removing unnecessary variation from surgical practice.
Initial carbon savings for the procedures studied were relatively modest (42.6 kgCO₂e per year), as the physical size of trays remained unchanged following rationalisation.
However, the study identified a more significant opportunity. In some cases, additional trays were being opened during procedures to access instruments not included in standard sets. By reducing this need through better tray design, the potential impact increases substantially:
- Estimated carbon savings of 3,612.9 kgCO₂e per year
- Estimated cost savings of £62,648 per year
MFT is now rolling out the rationalised trays across additional hospital sites, procedures and specialties, with further reductions in both carbon footprint and surgical costs anticipated.
If implemented at scale, this approach represents a practical, clinically led intervention that could support the NHS in meeting its target of net zero carbon emissions by 2045, while also improving efficiency across elective pathways.
This work will be taken forward by GIRFT through its Greener Pathways Programme and as part of its role within the UKRI/NIHR-funded Sustainable Health Systems (SHS) Hub, based at the University of Exeter.
The study was carried out by:
- Prakriti Shrestha, GIRFT Clinical Fellow
- Jane Roylance, Manchester University NHS Foundation Trust
- Toli Onon, Manchester University NHS Foundation Trust
- Anima George, Manchester University NHS Foundation Trust
- Janet Mathew, Manchester University NHS Foundation Trust
- Paul Goldsmith, Manchester University NHS Foundation Trust
- William D. G. Evans, Manchester University NHS Foundation Trust
- Katrein Savage, GIRFT, Senior Clinical Content Curation Manager
- Joseph B. John, GIRFT Lead for sustainable care pathway development
- Professor Tim Briggs, GIRFT Chair and NHS England’s National Director for Clinical Improvement and Elective Recovery
- William K Gray, GIRFT Academic Content Lead
