Becker's Clinical Quality & Infection Control

9 Executive Briefing: Patient Warming F or years hospitals have carefully managed expenses in re- sponse to various cost containment initiatives. As a result, many of the most obvious opportunities for leaner opera- tions have been leveraged. However, the pressures to deliver im- proved care at lower costs continue. Patient warming presents an excellent example of how facilities can glean more value from a current practice without significantly altering procedures or expenditures. An almost universal intervention Nearly every anesthetized patient in the U.S. undergoing a sur- gical procedure of an hour or more receives active warming to maintain normothermia, or normal body temperature. One modal- ity alone, forced-air warming, or FAW, is used in more than 80 percent of U.S. hospitals and treats more than 50,000 patients each day. 1 The clinical benefits of normothermia maintenance are well es- tablished, including reduced rates of postoperative wound infec- tions, decreased likelihood of postoperative myocardial infarction and shortened hospital length of stay. 2 Perioperative temperature management is included in clinical practice guidelines of anes- thesia, nursing, surgical and infection prevention organizations worldwide. It also has been part of CMS' Surgical Care Improve- ment Project and Hospital Compare, the government's public quality reporting website. Innovative facilities have found ways to extend this largely intra- operative intervention into a pre-op clinical and comfort tool and a contributor to patient satisfaction. Defining value in new ways Hospitals have long considered how products will improve or maintain the quality and safety of care in a cost-effective manner. Now the federal government's Hospital Value-Based Purchasing program outlines additional performance parameters with reim- bursement consequences. In fiscal year 2014 (Oct. 1, 2013 through Sept. 30, 2014), the three "domain" scores that comprise a hospital's "total perfor- mance score" for the VBP program are: • Clinical Process of Care Domain (45 percent) — Thirteen measures, including eight clinical measures culled from the Surgical Care Improvement Project. • Patient Experience of Care Domain (30 percent) — Based on Hospital Consumer Assessment of Healthcare Providers and System survey results, including eight criteria relating to effective communication, staff responsiveness, pain man- agement, facility cleanliness and quietness, and patients' overall rating of the hospital. • Outcome Domain (25 percent) — Three measures, including 30-day mortality rates for heart failure, pneumonia and acute myocardial infarctions. 3 VBP requirements demand continuous improvement. The reim- bursement impact of these measures is significant, yet for most hospitals, there are few additional resources available to pursue them. Here are five ways to make the most of the widespread practice of patient warming. 1. use patient warming gowns to enhance patient experience The patient experience domain is a major component of VBP with significant financial consequences for facilities. An older urban hospital in New Jersey projected potential losses of $240,000 in 2013 due to low satisfaction scores. An Atlanta facility anticipated a $230,000 satisfaction-related loss. 4 Both hos- pitals sought to bolster scores by improving amenities like adding flat screen TVs in patient rooms and doubling the number of TV channels available. While better TVs may be obvious improvements from the pa- tient's perspective, they are not clinical enhancements. Addition- ally, HCAHPS quality indicators, such as clear communication and clean rooms, may be practices patients assume have always been in place. Patients undoubtedly benefit from these important factors; however, they may not perceive them to be personally relevant. Ideal solutions offer proven clinical outcomes, measurable cost efficiencies and the ability to enhance the patient experience in a way that is immediately apparent to patients. Forced-air warming, which is primarily an intraoperative practice, is now available in a gown that patients can wear before, during and after surgery. Patients can adjust the temperature of the air flowing through this single-use gown to a level that meets per- sonal comfort needs. While patients have taken a dim view of traditional hospital gowns, they have reacted positively to forced-air warming gowns. A study of more than 1,800 patients showed that 83 percent of patients preferred the FAW gown (3M™ Bair Paws™ patient warming system) to a standard hospital gown. Patients also said that the warming gown kept them comfortable before surgery (86 percent) and had a positive impact on their surgical experience (73 per- 5 Strategies for Extracting More Value From Patient Warming Sponsored by:

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