Cates Alexandra C, Curtis Bradley J, Crockett Christy J
Department of Anesthesiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Paediatr Anaesth. 2025 Jul;35(7):520-526. doi: 10.1111/pan.15099. Epub 2025 Mar 20.
Children's body composition makes them highly susceptible to heat loss, which is further amplified by anesthetic-induced inhibition of thermoregulatory control. Perioperative hypothermia can lead to adverse outcomes, thus highlighting the importance of core temperature monitoring for pediatric patients undergoing general anesthesia. We launched and completed a quality improvement (QI) initiative at our institution starting in February 2023, with the SMART aim to increase the percentage of pediatric patients in our dental OR who receive a documented core temperature in the anesthetic record from 10% to 60% by October 2023.
We referenced the Standards for Quality Improvement Reporting Excellence guidelines and used the Model for Improvement with interventions tested via Plan-Do-Study-Act cycles. We tested 5 interventions between February and October 2023. These included an educational email to all anesthesia professionals, a posted sign in the OR, a Morbidity and Mortality Conference regarding core temperature monitoring, and the development of an integrated pop-up reminder to measure core temperature in our electronic healthcare record.
With this QI initiative, the percentage of pediatric patients undergoing general anesthesia for more than an hour in our dental OR with documented core temperature monitoring increased from 10% to 60% by October 2023, and to 90% by January 2024.
We successfully increased compliance with standard ASA monitoring guidelines. By January 2024, 90% of pediatric patients undergoing general anesthesia for more than an hour in our dental OR had documented core temperature monitoring in the anesthetic record.
儿童的身体组成使他们极易散失热量，而麻醉引起的体温调节控制抑制会进一步加剧这种情况。围手术期体温过低会导致不良后果，因此凸显了对接受全身麻醉的儿科患者进行核心体温监测的重要性。我们于2023年2月在本机构发起并完成了一项质量改进（QI）计划，其明确目标是到2023年10月将我们牙科手术室中在麻醉记录中有核心体温记录的儿科患者比例从10%提高到60%。
我们参考了《卓越质量改进报告标准》指南，并使用通过计划 - 执行 - 研究 - 行动循环测试干预措施的改进模型。在2023年2月至10月期间，我们测试了5种干预措施。这些措施包括向所有麻醉专业人员发送教育邮件、在手术室张贴标志、举办关于核心体温监测的发病率和死亡率会议，以及在我们的电子健康记录中开发一个集成的弹出式提醒来测量核心体温。
通过这项质量改进计划，到2023年10月，我们牙科手术室中接受全身麻醉超过一小时且有核心体温监测记录的儿科患者比例从10%提高到了60%，到2024年1月提高到了90%。
我们成功提高了对美国麻醉医师协会（ASA）标准监测指南的依从性。到2024年1月，我们牙科手术室中90%接受全身麻醉超过一小时的儿科患者在麻醉记录中有核心体温监测记录。
