Pathology at Royal Cornwall Hospitals NHS Trust, the main acute trust serving Cornwall and the Isles of Scilly from Treliske in Truro, has swapped single-use plastic specimen bags for reusable racks that each carry an RFID tag. In a case study published by NHS England South West in October 2021 as part of its Brilliant Care Week material, Jo Walsh of the pathology service at the Royal Cornwall Hospital put the baseline at almost 780,000 specimen bags arriving at the trust’s Blood Sciences laboratories over the course of a year, which she noted was more than enough to fill an Olympic sized swimming pool.
Bags inside bags, and then the incinerator
For many years the service relied on a single containment system for bloods submitted from primary care: the plastic bag. Earlier initiatives had added colour coded plastic bags so that prioritised samples could be picked out on arrival at the laboratory. Both worked as intended for containment and for preventing contamination. The difficulty sat at the other end of the journey. Because of the infection risk the bags had to be incinerated rather than recycled, so every one of them fed into the trust’s carbon footprint, and Walsh described the result as receiving samples within plastic bags within plastic bags.
What Indexor is
Indexor is a pre-analytical sample management and tracking system, part of the AlinIQ digital health portfolio sold and supported through Abbott’s Core Laboratory division. Rather than bagging tubes, the surgery loads them into a rack that is read electronically at both ends of the courier run. For Cornwall the objective was a plastic bag free containment transport system that also preserved the quality of the sample taken in primary care all the way to the bench, by recording temperature, transport time frames and any excessive G force vibration, and that allowed time sensitive priority samples to be identified on receipt in the laboratory so they could be processed promptly.
How the journey works
In the GP surgery, samples are labelled with electronically requested barcoded labels and scanned with an iMini scanner into an iRack. Abbott specifies the iRack as a durable polycarbonate rack holding up to 60 sample positions and taking tubes from 10 to 17 mm in diameter. The tubes go into the rack, and once the dedicated courier collects it the rack is placed inside an iLogger case, which starts recording transport information. Abbott describes the iLogger as an isothermal transport solution that secures samples vertically in racks and automatically records key transport data including temperature, impact and time, with support for ice packs where cooling is needed and a web dashboard offering sample-level tracking and error alerts on arrival.
At the laboratory the racks are loaded into docks, all the sample information is downloaded into the laboratory system, and the samples are ready for processing. Worklists are then interrogated for priority or time sensitive samples.
What the tag actually carries
The RFID tag in each iRack is written to, and what goes on it matters. In Cornwall it holds the barcode identification and the associated test, and deliberately holds no patient identification. Identity stays with the rack and its contents rather than with the person, which is a sound privacy decision for a reusable item that travels in a courier van between buildings and goes out again on the next round. The tag is also doing the job the colour coded bags used to do: priority and time sensitivity reach the laboratory as data on a worklist to be interrogated, not as a colour somebody has to spot. Terms used here are set out in our RFID glossary.
Seventeen surgeries, and a fondness for the zapper
By the time the case study was published the system had reached 17 surgeries, and the feedback reproduced in it from the participating practices was warm.
‘Just to say here at Lostwithiel we are all really pleased with our “zapper” – so easy to use and saving us all time and helping the planet as well!’
‘They are delighted with it – in fact staff thought it saved time which is even more impressive. Thank you so much for your flexibility with fitting in around us.’
Those comments appear in the case study as anonymous feedback from the surgeries taking part, other than the one that names Lostwithiel itself. The time saving is the detail worth underlining, because waste reduction projects in clinical settings usually ask staff to absorb a little extra work in return for less plastic, and by these accounts this one did not.
Elephants, and the vendor’s wider claim
Walsh set the target in units of elephant: pathology’s yearly plastic usage, comparable in 2021 to the weight of six elephants, cut to one and a half, and the case study calls that just the start of the department’s plastic reduction mission. The work sits under Greener NHS, the national programme driving the health service towards net zero, through its South West regional arm.
Cornwall is not the only UK pathology service running the system. Synnovis, the pathology partnership serving south east London, uses Indexor with its primary care users. Abbott states that some clients have seen a reduction in biohazard plastic waste by as much as 70%, a vendor figure drawn from across its customer base rather than a measurement taken in Cornwall. The Cornish numbers to judge it against are the ones Walsh published: almost 780,000 specimen bags a year before the change, 17 surgeries live, and six elephants of plastic down to one and a half as the goal.
Other RFID work in clinical settings is collected in our healthcare coverage, and waste reduction projects like this one in our sustainability coverage.
