Reducing the carbon footprint of the patient pathway for urinary tract stones

The third in GIRFT’s series of ‘greener’ pathways highlights the high-impact steps trusts can take to decarbonise the upper urinary tract stones pathway, helping to reduce the environmental impact of the NHS while improving patient care.

The latest green pathway has been developed in conjunction with the Royal College of Physicians (RCP), British Society of Urogenital Radiology (BSUR), British Association of Day Surgery (BADS), British Association of Urological Surgeons (BAUS), Royal College of Emergency Medicine (RCEM), Royal College of Anaesthetists (RCoA), Royal College of Surgeons of England (RCS) and the BAUS Section of Trainees (BSOT). 

The guide lists 18 high impact and practical clinical recommendations for decarbonising urinary tract stones care, covering prevention, diagnosis, treatment, surgery and outpatient management. For each, the potential annual emissions reduction across England is given if all trusts carried out all recommendations. 

For example, addressing the modifiable risk factors for stone formation by better educating patients on fluid intake, diet and metabolic health has the potential to reduce carbon emissions by an estimated 2,418 tonnes CO2e across England annually, as well as ensuring patients have fewer painful colic episodes and less time away from their usual activities. 

Similarly, streamlining follow-up of lower risk patients after renal stone treatment could reduce carbon emissions by an estimated 2,299 tonnes CO2e across England annually, meaning fewer healthcare encounters for patients and lower costs for the NHS. 

Each of the high impact recommendations is supported with key actions to achieve the carbon saving (e.g: using ultra-low dose computed tomography (ULD CT) rather than x-ray or ultrasound to detect residual stones, to help facilitate early informed decision making and discharge for many patients) as well as a rationale for the changes and the benefits for patients and the NHS. 

Overall, the guidance highlights measures with the potential to reduce carbon emissions by an estimated 9,901 tonnes CO2e annually – the equivalent carbon emissions to approximately four million cooked meals.