Issue link: https://beckershealthcare.uberflip.com/i/273133
11 Executive Briefing: Patient Warming cent). Almost 80 percent said they would tell a friend or family member about their experience with the warming gown. 5 For Ronald Sutton, OR business manager at Fawcett Memorial Medical Center in Port Charlotte, Fla., The Bair Paws system proved to be a significant addition to the facility in multiple ways. "Our primary goals were to increase our patient satisfaction scores, decrease the infection rates and meet new requirements for normothermia," says Mr. Sutton. "We wanted to do that across the board and not just on open general surgery cases." Fawcett Memorial began a trial of the product in November 2013, focusing on the outpatient department only. The impact on pa- tients was almost immediate. "In an environment where so much control is taken away from the patient, the fact that they had actually gained some control over their own comfort made them feel better," says Mr. Sutton. "We had pa- tient surveys done on these patients, and it was 99 percent positive." Given these positive reactions, it is clear to see how expanding forced-air warming use from intraoperative to pre-op— where pa- tients are awake and able to appreciate warming — can contrib- ute to the overall perception of care at a facility. 2. Begin warming efforts in pre-op In addition to enhancing patient satisfaction, adding preoperative warming to the patient warming protocol has yielded other benefits. Prewarming with forced-air warming before surgery can reduce an anesthesia-induced decline in core temperature called "redis- tribution temperature drop" that all anesthetized patients experi- ence. 6,7 Prewarming coupled with intraoperative FAW can prevent unintended hypothermia in procedures over one hour in length while reducing the frequency of hypothermia's associated nega- tive outcomes, such as an increased rate of wound infections, 8 increased length of hospital stay 9 and higher mortality rates. 10 Use of a temperature-adjustable gown that patients can control themselves also reduces the need for pre-op nurses to repeatedly retrieve warmed cotton blankets, freeing more time for other patient care matters. Patients who receive the FAW gown also arrive to the OR ready to be warmed. The gown can be attached to the intraop- erative warming unit, potentially saving both patient prep time and the need to use other normothermia products like FAW blankets. 3. use normothermia maintenance to adhere to quality initiatives The specifics of quality initiatives have changed over time, but the general objectives remain the same — improve the quality of surgical care, avoid adverse events, decrease infection rates and so on. Products and procedures should be assessed within these parameters. SCIP-INF-10, the perioperative temperature management quality measure, demonstrates how adherence to one measure may aid in achieving other quality initiatives. SCIP-INF-10 assesses the percent of surgery patients for whom ei- ther active warming was used intraoperatively for purposes of nor- mothermia maintenance, or who had at least one body temperature at or above 36°C 30 minutes before or 15 minutes after anesthe- sia end time. 11 The recently topped-out measure was introduced to help prevent the serious, costly and avoidable complications of unintended hypothermia, such as increased rate of surgical site in- fection and increased incidence of myocardial infarction — and SSI and MI are subjects of other quality initiatives. 12 By the time a measure is "topped out," or retired due to high per- formance nationwide, it is likely part of everyday practice. Howev- er, there is a move to replace process measures like SCIP-INF-10 with suitable outcome measures. A new outcomes-focused nor- mothermia measure has been drafted and is currently under con- sideration as an updated anesthesia quality metric. 13,14 Additionally, normothermia maintenance has been suggested as a potential quality measure for the federal Ambulatory Surgical Center Quality Reporting Program. 15 4. Obtain potential costs savings by avoiding unplanned hypothermia In cost-cutting mode, it is logical to look at line-item expenditures; however, it is important to consider costs in a larger context. A product or practice that reduces the likelihood of a complication could lead to financial benefits by: 1) eliminating the costs of treat- ing the complication; and, 2) allowing a quality measure and its associated reimbursement to be achieved. Maintaining normothermia reduces the risk for surgical wound in- fection, and the average cost of an SSI has been estimated at $25,000. 16 Hypothermic patients' duration of hospitalization has been shown to be 20 percent longer (2.6 days) than normother- mic patients. 17 A 2012 study estimates the average cost per in- patient day to be $1,629. 18 A day or two of hospitalization quickly adds up — certainly a concern in an era of preventing complica- tions and their associated expenses. One product also may reduce the need for others. Normothermia maintenance has been shown to reduce surgical bleeding and the need for blood products — significant when the mean acquisi- tion cost for a unit of blood is $203. 19 A forced-air warming gown can supplant traditional hospital gowns and the multiple cotton blankets used during each patient's perioperative journey. A major medical center in Texas estimated a potential annual cost sav- ings of $50,000 by using the FAW gown system instead of cotton gowns and blankets. 20 According to Fawcett Memorial's Mr. Sutton, use of the Bair Paws system was so efficient, the facility was able to significantly cut the amount of cotton blankets utilized. "Using the Bair Paws system, we were able to replace the cotton blankets with a sheet, which is cheaper to buy and launder. We reduced cotton blanket usage by 120 pounds per day," he says. 5. Seamlessly transition warming into future care models To save time and money, hospitals need to consider how well cur- rent practices will apply to new models of care. The development of accountable care organizations is among CMS' efforts to link payments to quality. A survey of 530 hospital leaders released in 2013 showed that more than half (55 percent) expect to be in ACOs by the end of 2014, up from the 22 percent participation level at the time of the survey. 21 ACOs move care away from the fee-for-service model and focus even more on pre- vention, evidence-based medicine and outcomes. Both existing and new products should be more closely assessed in terms of how well they fare against these areas of emphasis. Effective ACOs may also transition care from acute to outpatient settings. In the U.S., an estimated 60 to 70 percent of all surger- ies take place on an outpatient basis. 22 As more surgical patients seek outpatient care, acute-care hospitals are developing or ex- panding their outpatient facilities.