Problem: Poor/inadequate design of procedural kits for paracentesis, thoracentesis, and lumbar puncture at UCSF

Issue: The current procedural kits for the above procedures are inefficiently packaged with either excess items not frequently used (and often wasted, despite efforts to partner with the medical school's REMEDY chapter to repurpose these items in other settings) or do not have adequate supplies of more necessary, higher-yield items, leading to excess medical waste and provider time getting additional supplies.  For example:

(1) paracentesis/thoracentesis kits: have plastic drainage bags/associated tubing that, when adequate vacutainers are available (recognizing there is a current shortage), never get used (we save these for a rainy day, but rarely use them--much more time-intensive/not practical for large volume procedures, and so have a large unused stockpile)

(2) paracentesis kits: as above, as well as: include extra 22-gauge needle and spinal needle that are rarely used and often tossed out; include glass top vials but no filter needles; do not include Chloraprep (which is preferentially used over iodine for several reasons); do not include Tegaderm. There are similar suboptimal design issues with the alternative Turkell kits.

(3) LP kits: have inadequate lidocaine included for the vast majority of LPs, inadequately sized syringes, inadequate gauze, has sponges included (but no iodine) and no Chloraprep.

Idea: UCSF has significant purchasing power and could discuss with the kit manufacturers redesigning the kits we currently use tailored to our local practices to reduce medical waste, wasted provider time searching for extra supplies required, and improve work flow. 

In addition, as director of the Hospitalist Procedure Service, I would favor discontinuing use/stocking of the Turkell kits for several reasons (including that the "safety" mechanisms are impractical) and using one, properly designed kit to be for all paras/thoras. This would also streamline the ordering/stocking process and standardize provider familiarity/ease with learning only one kit (hopefully improving procedural quality/safety).