The National Health Service (NHS) faces increasing financial and environmental pressures, driving the need for sustainable clinical practices without compromising patient care. In line with the GreenED and NHS Net Zero initiatives, this quality improvement project aimed to assess the frequency and appropriateness of grey (fluoride oxalate) and blue (citrate) blood bottle use in the Emergency Department (ED). Data were collected over three separate 24-hour periods, reviewing all blood samples obtained during those times. Each grey and blue bottle request was evaluated against current clinical guidelines to determine justification. Preliminary analysis showed that a substantial proportion of bottles were requested without clear indication, often due to routine “full panel” requesting or lack of awareness regarding test-specific indications. These findings highlight the potential for significant cost savings and reduced environmental impact through more rational test ordering. The project underscores the importance of education, local guidance, and awareness to promote resource stewardship and sustainable practice. Ongoing work will include staff engagement, educational interventions, and re-audit to measure long-term effectiveness. This initiative reflects the principle of “Cutting Cost, Not Care,” demonstrating how small, evidence-based changes in routine practice can enhance both environmental responsibility and operational efficiency in the Emergency Department.

Muthusankar Sudalaimuthu is a Clinical Research Fellow in the Emergency Department at Morriston Hospital, Swansea Bay University Health Board, United Kingdom. With a strong foundation in emergency medicine, he is dedicated to improving clinical efficiency, patient safety, and environmental sustainability within acute care. His current research focuses on optimising resource utilisation in the Emergency Department, particularly by reducing unnecessary laboratory investigations through his project “Cutting Cost, Not Care,” which aligns with the NHS Net Zero and GreenED initiatives. He has led several quality improvement projects, including work on infection prevention and rational use of diagnostic consumables, reflecting his commitment to sustainable and evidence-based practice. He also has a growing interest in the role of artificial intelligence in emergency triage and clinical decision support to improve patient outcomes and operational efficiency. Through his combined experience in research, innovation, and frontline emergency care, he aims to contribute to the development of a safer, smarter, and more sustainable model of emergency medicine that balances clinical excellence with environmental responsibility.