#410 Trying to reduce unnecessary carbon in haemodialysis (TRUNC-HD) — a regional sustainability quality improvement project

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Abstract Background and Aims Healthcare contributes 4–5% of global carbon dioxide equivalent (CO2e) emissions. Haemodialysis (HD) contributes disproportionately to this due to its resource-intensive nature. Dialysis services in Yorkshire launched Trying to Reduce UnNecessary Carbon in Haemodialysis (TRUNC-HD), a regional quality improvement (QI) initiative to reduce the environmental impact of HD, building on established renal sustainability programmes within the region. Method A sustainability fellow and a regional QI manager engaged and collaborated with stakeholders across participating dialysis services. Local teams attended four face-to-face workshops using modified sustainability-focused (susQI) tools to design and implement interventions. Regional meetings, held thrice annually, facilitated progress sharing and collaboration. Baseline and progress data were gathered to assess environmental and financial impacts. The greenhouse gas (GHG) savings was quantified in carbon dioxide equivalent (CO2e) and calculated using hybrid carbon footprinting methodology. Data sources to calculate the GHG savings including direct measurements where available, the Department for Energy Security & Net Zero and Department for Environment Food & Rural Affairs 2024 greenhouse gas conversion factors, published carbon footprint estimates of medical equipment and expert opinion. Results Between January and December 2024, interventions included using 1:44 instead of 1:34 dialysate acid concentrate, reducing machine heat disinfection cycles, reducing dialysate flow rates, encouraging patients to bring personal blankets instead of unit-provided blankets that must be laundered after every single use and waste reduction. Waste management strategies included reducing food waste, recycling empty acid concentrate canisters, switching from single use to reusable domestic items and streamlining fistula cannulation packs. Combined, these interventions are estimated to achieve annual savings of 45 tonnes of CO2e and £70397 (Table 1). Patient experiences and outcomes were monitored during the intervention period. Patient-centred initiatives, such as encouraging personal blanket use, improved patient experience and comfort. Two centres observed that optimising machine heat disinfection cycles reduced the wait time for machines to be ready for dialysis, thus improving patient flow and satisfaction. A preliminary 2-month review of dialysis adequacy after reducing the dialysate flow rates from 800 to 500 ml/min in a single unit showed no adverse impact on dialysis adequacy. Feedback from the workshops and regional meetings highlighted the value of collaboration which fostered teamwork, leadership and QI skills within multidisciplinary teams. Conclusion In summary, the TRUNC-HD initiative demonstrates the impact of a regional, collaborative approach to addressing climate change, delivering environmental and financial savings, professional development, and service improvements. Scaling up current interventions regionally could achieve annual savings of approximately 120 tonnes of CO2e and nearly £200,000 per year.

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