Along the course of the project, quarterly committee meetings and departmental monthly meetings served as venues to express concerns and look for areas of improvement, such as specific patterns or trends leading to hypothermic patients. One specific example was the identification of the gastrointestinal endoscopic patients having a rate of hypothermia that was 2% higher than average. Directed education on the importance of Bair Hugger blankets and using warm intravenous fluids worked well to decrease the rate of hypothermia in these patients. This collection of data was shared at regular intervals during monthly department meetings as well and more frequently using departmental emails. The hospital’s secure intranet SharePoint (Microsoft) site was used to share the data among providers.
Study of the interventions and measures
To study the effectiveness and impact of the project to motivate our anesthesiologists and other team members, we compared the first temperatures obtained in the recovery unit prior to the start of the intervention with those collected after the start of the QI project in November 2018. Because of the variability of temperature monitoring intraoperatively (nasal, axillary, rectal), we decided to use the temperature obtained by the nurse in the recovery room upon the patient’s arrival. Over the years analyzed, the nurse’s technique of measuring the temperature remained consistent. All patient temperature measurements were performed using the TAT-5000 (Exergen Corporation). This temporal artery thermometer has been previously shown to correlate well with bladder temperatures (70% of measurements differ by no more than 0.5 °C, as reported by Langham et al16).
Admittedly, we could not measure the degree of motivation or internalization of the project goals by our cohort, but we could measure the reduction in the rate of hypothermia and subjectively gauge engagement in the project by the various groups of participants and the sustainability of the results. In addition, all participating anesthesiologists received MOCA Part 4 credits in July 2019. We continued our data collection until April 2021 to determine if our project had brought about sustainable changes in practice that would continue past the initial motivator of obtaining CME credit.
Analysis
Data analysis was performed using Excel (Microsoft) and SAS, version 9.4 (SAS Institute).
The median of the monthly percentage of patients with a temperature of less than 36.0 °C was also determined for the preintervention time frame. This served as our baseline hypothermia rate, and we aimed to lower it by 50%. Run charts, a well-described methodology to gauge the effectiveness of the QI project, were constructed with the collected data.17