Keep calm and stay warm: a QI project to optimise perioperative temperature control in paediatric anaesthetics at the Evelina London Children’s Hospital

Abstract

Background: Hypothermia is defined as a core body temperature <36°C.1 Complications of anaesthetic-related heat loss include delayed recovery and increased risk of surgical wound infection.2 Predominantly owing to a smaller weight-to-surface-area ratio,3 this is more common in paediatrics. With ∼45.1%4 of cases involving at least one hypothermic episode, it is vital that body temperature is regularly monitored and corrected throughout the perioperative period. We aimed to increase the percentage of anaesthetic charts with temperatures recorded at the correct time intervals according to the Evelina guidelines for perioperative temperature control by 20% by mid-February 2023. Methods: After an initial shadowing exercise observing temperature recording in practice, we created driver diagrams and completed two PDSA (plan-do-study-act) cycles: 1. a 30-min presentation to key stakeholders on the importance of perioperative temperature control and current local guidelines; 2. we displayed posters containing cycle 1 results and a summarised guideline flowchart. Data were collected over 18 weeks and analysed using descriptive statistics. Results: At baseline, 8.4% of temperature measurements were recorded correctly. After intervention 1, this increased to 8.8% and 13.6% after intervention 2. A 5.2% increase was noted overall. Conclusion: Our results indicate that reminder-based interventions can improve guideline compliance within a short timeframe and at low cost. However, we were unable to reach our aim. A questionnaire distributed to the team revealed that 75% (n=3) felt the interventions provided useful reminders of forgotten information while 56% (n=5) were absent from the presentation. Staff engagement should hence be prioritised in future. Further PDSA cycles may also consider reiterating the guidelines by other means (e.g. attaching reminders to anaesthetic desks). As many commented on paper charts being a hindrance for timely documentation, electronic prompts that indicate when recordings are to be made may also be considered. 1.Hart SR, Bordes B, Hart J, Corsino D, Harmon D. Ochsner J 2011; 11: 259–702.Diaz M, Becker DE. Anesth Prog 2010; 57: 25–333.Nemeth M, Miller C, Bräuer A. Int J Environ Res Public Health 2021; 18: 75414.Görges M, Afshar K, West N, Pi S, Bedford J, Whyte SD, et al. Pediatr Anesth 2019; 29: 27–37