Closing the audit loop--prevention of perioperative hypothermia: audit and reaudit of perioperative hypothermia.

BACKGROUND AND OBJECTIVE

Perioperative hypothermia is generally regarded as undesirable, but its incidence rate in the elective procedures in our hospital and the effect of the preventative measures taken against it were unknown. An initial audit indicated that postoperative hypothermia occurred. Therefore, changes in practice were implemented to address the problem. A further audit was then undertaken to assess the impact of these measures.

METHODS

The first audit recorded data from 177 patients undergoing major elective surgical procedures. Variables recorded were: ASA classification, duration of operation, use and description of preventative measures for hypothermia, blood loss, intravenous fluids, and core and peripheral temperatures on arrival and discharge from the recovery room. The subsequent audit included 158 patients undergoing major general, orthopaedic or vascular surgical procedures. Patients had core temperatures measured preoperatively, immediately upon arrival in the recovery room, and just before discharge back to the ward. Core temperatures in both audits were measured using an infrared temperature probe.

RESULTS

The mean body temperature on arrival in the recovery room of patients in the initial audit was 35.5 degrees C (range 32.2-37.2, SD +/- 0.74), and in the subsequent audit 36.6 degrees C (33.6-38.2, +/- 0.72). These differences reached significance (P < 0.0001). This was despite an average duration of surgery of 133.5 (25-330) min in the initial study compared with 154.7 (90-480) min subsequently.

CONCLUSIONS

We found that with simple but consistently implemented changes in practice, postoperative hypothermia in elective patients could largely be eradicated.