3 2 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E J U LY 2 0 1 5
Many patients arrive in the chilly early-morning hours. "Just based on circadi-
an cycles alone, people have lower body temperatures then," says Ms. Burns.
"Added to that, they're removing clothing in what might be a cold clinical envi-
ronment." Makes you shiver just thinking about it.
How long does it take to adequately pre-warm patients? A half hour is a good
target to shoot for, experts say, but something is always better than nothing.
"You certainly would not delay surgery because it's only been 20 minutes," says
Daniel Sessler, MD, Michael Cudahy Professor and chair of the department of
outcomes research at the Cleveland Clinic. "Pre-warm patients to the extent
that it fits into your routine." Ideally, set up your pre-op protocols in such a way
that they include half an hour for pre-warming.
Granted, it costs money to pre-warm patients. "But I absolutely think it's a
good investment," says Ms. Burns, who notes there are a lot of things in health
care we have to spend money on, and there's no physiological reason not to pre-
warm everyone. "Here's the other side of that coin," she adds. "If you're going to
shorten the hospital stay or shorten the PACU stay (by pre-warming), you're
going to save hundreds of thousands of dollars a year. We see it in the PACU.
Patients have shorter stays when they don't come in as hypothermic."
If you're not convinced that spending the extra dollars to pre-warm makes
total sense, Ms. Burns suggests you at least use pre-warming for particularly
high-risk patients. "Those going to have open procedures of any kind, and all
pediatric patients as well as those who are frail, elderly or who have multiple
comorbidities," she says.
"I can't think of any adults in whom pre-warming would be contraindicated,"
comments Dr. Sessler. "It requires some effort, but the effect is real and measur-
able, even if it's relatively small."
2. Double up
The list of reasons to use forced-air warming in the OR is long: It's safe, effec-
tive, inexpensive and easy to use. But hypothermia is a powerful foe. So why
