Dialysing Nearer to Home

SusQI project completed as part of the UK Kidney Association and Centre for Sustainable Healthcare Kidney Care Sustainability Group Scholars Programme.

Scholar: Dr Rosa Montero
Team members: R Calayag, L Espiritu, R Cubita, Finance Team

Background
The rising number of patients requiring dialysis has also seen an increase in the use of hospital transport for our dialysis patients to attend three times a week to our dialysis units. Renal is known to be the largest users of hospital transport. Our three satellite haemodialysis units cover different areas with transport taking up to two hours to pick patients up from their home to up to 2 hours to collect them from the unit to take them home. This project explored how to improve patient experience, increase active travel of patients to the satellite unit and reduce hospital transport.

Specific Aims
1) Dialyse patients nearer to home thereby reducing carbon footprint due to travel
2) Encourage patients who have moved nearer to their home to use active travel or public transport to reduce hospital transport costs.

Results
Total number of patients to transferred nearer to their unit = 39

Patient outcomes:
Patient satisfaction increased. No change in DNA rate as precipitated by illness/did not DNA previously, and one patient began attending full sessions.

Population outcomes: Health outcomes may be improved with reduction of polluting vehicle transporting longer distances.

Environmental benefit:
KgCO2e from manufacturing of transport was not included in the calculations. Total mileage saved = 151.9. Estimated carbon emissions from a Class 1 vehicle (diesel van) from tail pipe and well-to-tank emissions = 0.22875kgCO2e + 0.05572kgCO2e = 0.28447kgCO2e per mile.

Overall reduction for moving 39 people closer to home in a single centre =0.28447kgCO2e x 151.9 miles x3 sessions per week x 52wks = 6.74 tonnes of CO2e per year.

There are 52 renal unit referring centres each with 2-5 satellite units. Moving a small number of people per centre to their nearest unit could potentially save 350 tonnes of CO2e per year showing the importance of each unit mapping the unit distance from patients’ homes. Home haemodialysis would reduce CO2e transport emissions further by removing the need to travel.

Economic benefit:
Cost current unit travel £1517.92 (walker)
Cost nearest unit travel £1051.41 (walker)

Total cost current unit – cost nearest unit
Minimum Total savings: £466.51 per session for walkers x 3 sessions per week = £1399.53 x 52 weeks = £72,775.56 per year

Two walkers changed to no transport making additional savings.
Decreasing need of patients with single/double handed crew, stretcher or bariatric would increase financial savings further.

Social sustainability:
Total time saving: 554 minutes for 1 session.

Patient feedback: ‘I can spend more time with my children as I don’t feel so tired ondialysis days’, ‘I now have a full time job, it’s made such a difference’, ‘my husband expects me to do the dinner but although I’m nearer I still feel really tired after dialysis, it washes me out’, ‘I can walk there and get back home quickly, it’s great I’ve got some of my life back’.

Conclusions
This project has allowed us to improve patient experience whilst impacting positively on the environment and reducing financial spending looking at the triple bottom line. Key elements of success were the renal IT expert to map the patients and our units out, the satellite matron who asked patients and active promotion of the benefits of dialysing nearer to home by staff at the satellite units.

Going forward we are maintaining waiting lists and where possible allocate people directly to their nearest unit. Every year we plan to repeat the mapping exercise to ensure the dialysis unit continues to be the one nearest to the patient.

For more information see attached report.