SusQI case study: Eliminating the second group and save prior to laparoscopic cholecystectomies

Rachel McLean's picture


Resource Description: 

SusQI project completed at University Hospitals Sussex NHS Foundation Trust, as part of the Green Surgery Challenge, 26/04/2021 – 07/07/2021. The case study attached has been updated to reflect progress as of June 2022. 


Project Aim: To eliminate the second group and save (G&S) blood test in the preoperative pathway for laparoscopic cholecystectomies (LC) at University Hospitals Sussex NHS Trust.

Method and measurement:

A process map (Appendix 1) was created to identify areas of waste and low value activity, namely the second G&S blood test. We engaged with a wide variety of staff and patients via a short survey to understand the social impacts the change could have. A patient safety audit was conducted via review of LCs performed at the trust. A rapid literature review was performed to identify studies reporting transfusion or bleeding rates post-LC. A basic cost analysis of the G&S was undertaken with the prices extrapolated to the audited patient group. To consider environmental impact, we calculated data on the average miles travelled per patient, the items involved in the collection of blood tests, personal protective equipment used by clinicians and the weight of materials going into clinical waste incineration. Using respective carbon emissions factors, we determined the CO2e saving.


Our audit and literature review supported the hypothesis that eliminating of the second G&S is likely to be safe. By doing so, up to 2.5 tonnes CO2e per year and >£3000 (based on a conservative estimate of 250 cases) could be saved. Social benefits include reducing inconvenience and travel costs to patients and reducing concerns of low value or over-investigation of patients, increasing clinical pressures.


We demonstrated that eliminating the second G&S in the preoperative workup for LC procedures is a safe intervention. Across the UK, approximately 61,220 LCs are performed every year. The elimination of this one blood test could therefore save over 600 tonnes of CO2e annually, as well as save resources such as blood bottles of which there was recently a shortage across the UK. The reduction of testing also adds social benefits of increased convenience to patients, and reduced workload for staff.


Mr Shameen Jaunoo, Consultant General, Upper GI and Laparoscopic Surgeon

Professor Mansoor Khan, Consultant Oesophagogastric, Trauma and General as well as Honorary Clinical Professor of Trauma Surgery

Dr Alyss Robinson, Foundation Year 2 trainee at Brighton & Sussex University Hospitals.

You can read more about the project by downloading the attached case study or at this link: Introducing Team 3 of the Green Surgery Challenge | Centre for Sustainable Healthcare

You can read more about the Green Surgery Challenge and watch the recording here: Green Surgery Challenge | Centre for Sustainable Healthcare

Resource File: 

Publication date: 

June, 2022

Resource type: 

  • case study


Reshare request

Sheri Scott's picture

Very interesting - great work.

Would you be happy for me to reshare this on our Clinical Labs susnet site?

Great idea Sheri - I've

Susannah McWilliam's picture

Great idea Sheri - I've shared on the Clinical Labs Susnet now

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