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Home E-Weekly October 1, 2020

The Financial Argument for Patient Warming

Published: October 15, 2020

The numbers don't lie: Cost savings add up and outcomes improve.

In 2017, a staggering 70% of Parkland Hospital's procedures included a hypothermic incident. The Dallas institution wanted to determine if prewarming patients helps keep them normothermic during and after surgery, so it conducted a small study over a four-week period. It prewarmed patients for 30 minutes in cotton blankets warmed to 130°F. In the OR, forced-air warming, warmed IV fluids and warmed irrigation fluid were used. Finally, warmed blankets were draped on patients during transport to the PACU.

Parkland documented patients' temperatures in pre-op, when they entered the OR and the PACU, and 30 minutes after arrival in the recovery unit. Of the 63 patients involved in the study, 20% were hypothermic in pre-op, 32% in the OR, 41% in the PACU and 7% after 30 minutes in recovery. These percentages were all well below 70%, the national average of inadvertent perioperative hypothermia (IPH) in 2018.

"We would have loved to use active warming measures in pre-op, but our budget couldn't handle the investment," says Justin Buchert, MSN, MEd, MS, RN, a quality specialist for surgical and trauma services at Parkland. "We instead opted for the warmed blankets because our hospital already owned two refrigerator-sized warming units, and they were at our disposal."

Parkland's literature review revealed that the average cost of an IPH event is $7,000. Besides that, the hospital determined patients would have shorter lengths of stay due to patient warming, which further cut costs. Parkland ultimately identified $2.35 million in potential savings from the study.

"Our study proved warming patients throughout the entire surgical process ultimately pays off big," says Mr. Buchert, who adds that a secondary benefit to maintaining normothermia is a reduction in patients' stress levels.

Potential multimillion-dollar savings weren't enough to move the needle at Parkland, however. "Considering our study's relatively low cost, you'd expect the hospital's stakeholders would have been all in on enhancing our patient warming protocols. They weren't," says Mr. Buchert. "Changing mindsets is hard. Most OR staff members are Type A personalities. We have our way of doing things, and change becomes personal. We understood getting the results we needed would involve changing mindsets because it involved changing routines." In addition, those changes to the routine would need constant, consistent reinforcement.

Interestingly, to foster buy-in, the rollout of the warming protocol wasn't made to the entire staff at once. "Our approach was one on one," says Mr. Buchert. "If I talked to a nurse, the message was: This warming protocol is directly improving patient care. It is a level higher than what we're doing now." He also reminded each staffer that the warming protocol was evidence-based, and that patient warming had been approved by numerous organizations and the Joint Commission.

"If you're considering a prewarming program that will require multi-level buy-in, tailor your approach to each stakeholder's role," advises Mr. Buchert. "Your surgeons need to be approached differently than OR staff. If we spoke to physicians, the message was fact-filled: Patients can go home earlier, there will be a lower chance of surgical site infections and you will reduce recovery times, which could ultimately allow you to do more cases."

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