Mapping Greener HealthcareMapping Greener Healthcare

Goal: to assess the value of home haemodialysis compared to in-centre haemodialysis in financial, environmental and social terms. The service currently supports 18 patients to undergo home haemodialysis.

Background: the renal service has been aiming to increase the number of patients receiving haemodialysis at home to improve the financial and environmental impact of haemodialysis as well as to improve the patients’ experience of care. Home haemodialysis uses less water - 152 litres/week/patient on average compared with 360 litres/week/patient in conventional in-centre treatment. Consumables such as plastic and cardboard packaging can be recycled by the local council in the domestic recycling. Utility costs involved in the haemodialysis service are borne by the Trust and reimbursed to the patient. Renal nurses visit the patients at home to oversee care. The process of home haemodialysis is less demanding from a cardiovascular perspective (i.e. less stressful on the heart) as haemodialysis occurs over a longer time. There is evidence that patients undergoing haemodialysis at home:experience an improved symptom profile (improved energy, appetite and sleep), live longer and take fewer medications.

Results: The calculations assume savings as if all these patients were new to the service and would have been on in-centre dialysis. Note that results are based on water use as water use was the largest difference between in-centre and home haemodialysis. Travel (of patients travelling to the units and renal nurses visiting the patients at home) and electricity could also be considered in calculations. A reduction in medication also has a positive impact on the environment, but as there was no data available it has not been included in the calculations.

Cost: savings due to reduced water use amounted to £1,577 per year for the 18 patients.

Environmental: savings of water use per year were 194,688 litres, with a carbon footprint reduction of 177 kgCO2e.

Social/health: there is evidence from the literature of patients undergoing home having a better experience of haemodialysis, however no assessment of the social impact/patient experience was carried out as part of this project.