Normothermia Is Good Business

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Surgical facility leaders say patient warming pays for itself.


It costs the Graystone Eye Surgery Center in Hickory, N.C., $1.05 to warm a patient. A loaner linen service charges $1 to clean a blanket, and the cost of using the blanket warmer is nominal, about 5 cents a case.

“Patients often comment on how much they enjoy warm ‘real’ blankets,” says Ann Leary, RN, Graystone’s infection control and perioperative supervisor. “Greater patient satisfaction leads to an enhanced reputation in the community, which generates patient referrals.”

How do you put a price on a warm patient? We surveyed nearly 100 readers last month to see if they knew how much it costs to prevent hypothermia. Though most didn’t, more than 94% of respondents agreed that there is a clear economic benefit to preventing hypothermia. The few respondents that did do the math estimated warming costs $5 to $30 per case. And those who don’t know, don’t care because the costs to prevent hypothermia are offset by the expensive clinical complications that patient warming works to prevent, not to mention the patients who appreciate the warmth.

At Artesia (N.M.) General Hospital, warmed blankets and forced-air warming come to about $30 per patient. A 3-pound blanket costs $1-a-pound to wash, and about 6 blankets are used on each patient. A forced-air blanket costs $6 to use per case, and 2 are usually used during each procedure. Money well spent, says Randall Rentschler, perioperative director at Artesia. “Warming deceases lengths of stay and helps to prevent infections,” he says. “Both have economic benefits.”

John Lewis, BSN, MHA, director of surgical services at Evangelical Community Hospital in Winfield, Pa., estimates patient warming costs $10 to $15 per patient. They use a forced-air system and spinal underbody blankets. These techniques have contributed to his facility’s SSI rate of 0.1%. “Decreased incidence of SSI and faster extubation are clinical benefits that have real economic value,” says Mr. Lewis.

Sheri McDuffie, BSN, RN, nurse and perioperative educator at Christian Hospital in St. Louis, Mo., says she doesn’t know how much warming patients with blankets and forced air costs. Guess what? “It doesn’t matter if it’s effective,” she says, adding that warming produces faster healing and reduced risks of SSIs. “Our patients love our warmer gowns in pre-op. They are much more comfortable and at ease prior to their surgery.”

Doris Terwilliger, ADN, OR manager at Guthrie County Hospital in Guthrie Center, Iowa, says warming patients costs $5 to $10 per case. They focus on the clinical benefits, such as faster healing and recovery times, which means less time in a stretcher and faster discharge. “We do this because it is a standard of care and to keep our patients comfortable,” says Ms. Terwilliger.

Patient satisfaction is priceless

Charles Golden, MSN, CRNA, of Img Anesthesia Services in Nashville, Tenn., perhaps says it best: “A warm patient is a happy patient.” Happy patients are good for business. Positive reviews of your facility could result.

“A comfortable patient may give a good review,” says Krystie Berberich, BSN, administrator at The Kidney & Hypertension Centers Lifeline Vascular Access Center in Cincinnati, Ohio. “An uncomfortable patient is very likely to give a poor review of the facility.”

One respondent at a facility that warms all patients with a forced-air warming system says patient satisfaction scores for patient comfort throughout the surgical process have improved. The surveys also see fewer complaints of unmanaged pain.

“There is a small cost per patient, which saves recovery time from hypothermia,” another respondent notes. “The cost of unhappy, cold patients should be measurable.”

Above and beyond

  |  Pamela Bevelhymer, RN, BSN, CNOR

To say the least, the staff at Advanced Surgical Center leaves no patient warming box unchecked. Keeping patients warm and cozy is clearly a central component in the overall clinical strategy at the ASC in Duncanville, Texas.

The forced-air warming system is turned on before the patients arrive. Socks, gowns and blankets are warmed. But wait, there’s more. The staff also warms the IV fluids. And by placing the patient prep and the blood pressure cuffs atop the forced-air system before procedures, they are warm as well when they touch the patients’ skin. The staff even places thick, warm, very popular expensive gel packs under the patients’ feet. (More on those later.)

“I’m a really big advocate of patient comfort,” says Darleneya Robinson, RN, the facility’s nursing director of surgical and anesthesia services. “We keep them warm for better outcomes, but just the fact that they’re warm also increases overall patient satisfaction.”

In addition to all of the clinical advantages patient warming facilitates, Ms. Robinson agrees that there is a clear economic benefit to preventing hypothermia. She adds that satisfied patients are also more likely to refer friends and loved ones to your facility, or return themselves if they need another procedure.

“When I have a warm patient, they’re not shivering, which means their discharge is going to be facilitated better and sooner,” says Ms. Robinson. “If they’re shivering, I’m holding on to my patients longer. And if I’m holding on to my patients, that means I’m holding on to my nurses, which can be anywhere from $400 to $700 for that extra time.”

Many ways to warm

Nearly 86% use a forced-air warming system, and 80% use cotton blankets pre-warmed in a blanket warmer. Lesser-used methods: 14% use a spinal underbody blanket, thermal mattress or bed pad on which the patients lie; 8% use radiant warming devices and nearly 6% use conductive polymer fabrics that warm patients from above and below simultaneously.

Eva Robbins, RN, BSN, surgery/specialty manager at Carroll County Memorial Hospital in Carrollton, Ky., says they warm all patients with cotton blankets from a warmer, as well as a forced-air warming system. The practice leads to happy patients and averts clinical complications, she says.

“We continue to have satisfied patients, and we do not have any hypothermia cases in our surgery department,” says Ms. Robbins.

An underused solution?

About 37% of respondents said they do not routinely warm patients. That’s not enough, says Anita Volpe, DNP, APRN, director of surgical outcomes, research and education at NewYork-Presbyterian Queens in New York City.

“Based upon all the evidence-based literature available, active pre-op warming should be a protocol for all patients,” says Ms. Volpe.

Ms. Volpe has implemented warming protocols in 2 large facilities and says the pre-operative warming practices make a significant difference in achieving positive patient outcomes.

Abdul Ghaffar Soomro, MSN, director of surgery and perioperative services at Prime Healthcare in Nogales, Ariz., agrees. “Warming of surgical patients, starting in the pre-op area and continuing until discharge, especially during the intraoperative period, is crucial,” he says.

One respondent noted that dealing with an infection is expensive. “Research has shown a higher incidence of infection when temperatures are too low or too high. From a financial standpoint, keeping patients warm in a cold OR will help prevent infections, which we all know can cost thousands of dollars [to treat],” says the respondent.

Rationales for whom to warm

Nearly 62% of respondents say the length of surgery and 60% say the type of procedure are factors in whether to warm patients. Deborah O’Toole, BSN, perioperative manager at Stony Brook Eastern Long Island Hospital in Greenport, N.Y., says all patients are warmed using warmed blankets or forced air, regardless of procedure type. She says the costs are negligible, and thinks the money saved due to shorter recovery times more than offsets the nominal expense of warming.

The OR’s room temperature is a factor for 38% and the age of the patient is a consideration for 37%. Nearly 36% take the type of anesthesia into account, and a patient’s ASA status and pre-existing medical conditions are a factor for one-third of respondents. A patient’s BMI is a consideration by 15% of those who responded, and nearly 4% weigh the patient’s gender.

Ms. Robinson says the warming practices she uses are patient- and procedure-specific.

“People come to us from outside in the 100-degree Texas heat to the lobby, then to the waiting room, then to our OR, which is around 64 degrees,” she says. “All of those transitions have an effect on the body, and a little old lady with a low fat content will handle that differently than a morbidly obese man.”

Costs offset by savings

Cindy McClement, BScN, RN, manager of perioperative services at Trillium Health Partners in Mississauga, Ontario, Canada, says her facility spends several thousand dollars a month on patient warming. They routinely warm patients, and Ms. McClement says there are economic as well as clinical benefits.

Cost savings from patient warming can be hard to quantify, but are obvious. Clinical complications increase costs to patients and facilities. Warming has been shown to reduce those expensive complications.

Ms. Robinson estimates that warming costs her facility somewhere close to four figures a year, which includes having to replace the popular gel packs that mysteriously disappear.

“They’re 150 bucks each, but the patients love them,” she says. “I can’t prove it, but I know some patients have taken them home.”

The gel pads are thick, comfortable and washable. “They’re expensive, but you know what? That’s not how I think about it,” says Ms. Robinson. “I think about it like, if our patient is shivering or gets an infection because she’s cold, now I have a patient transfer, which is $1,200 to $1,500 for the ambulance alone.”

And such transfers could include regulatory follow-ups, which take time, and thereby cost money.

Ms. Robinson says the warming at Advanced Surgical must be working, as there have been virtually no SSIs or hospital transfers in the 3 1/2 years she has been there.

While it might sound overly simplistic, Ms. Robinson says it’s important to keep in mind that patients are coming in for surgery, so they’re stressed. Most aren’t thinking about the risks of clinical complications. After it’s all over, all they know is that the procedure itself went well — and what they remember most is that they were warm and cozy throughout the process.

“Some of our patients go to aftercare at the doctor’s office next-door and they stop in with cards, brownies and hugs as a thank you,” says Ms. Robinson. “When that happens, we know we’ve done our job. Their comfort level when they were here is a huge part of that.” OSM

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