Better Outcomes, lower costs: How an innovative approach to patient warming supports value-based care goals

Posted by Lauren Burke on

Around 20 percent of patients experience unintended perioperative hypothermia, which can contribute to negative care outcomes. When body's core temperature drops 1.5°C within 30 minutes of anesthesia administration, the average patient's surgical blood loss increases by 16 percent and patients are at a 22 percent increased risk of needing a transfusion.1 Patients with unintended perioperative hypothermia are also at three-times higher risk for surgical site infection and three-fold greater risk for morbid cardiac events. Clinical complications are just the beginning; treating patients with unintended perioperative hypothermia often requires the use of additional hospital resources. Hypothermic patients typically take around 40 minutes longer to recover from surgery and on average report 20 percent longer hospitalization than non-hypothermic patients. 2

However, surgical teams are not without solutions. Clinical studies suggest 30 minutes of prewarming can reduce the risk of subsequent hypothermia.3 Clinicians can also monitor the patient's body temperature to prevent complications. This article examines the clinical benefits of patient warming and outlines the advantages of the Enthermics ivNow fluid warmer. With a focus on improving quality of care and OR efficiency, this innovative technology can help providers succeed in value-based care.

The benefits of patient warming Launched in 1980 as a pioneer in whole body hypothermia research, Enthermics has developed a host of patient warming technologies including blanket and fluid warming cabinets. Since then, Enthermics has continued to develop patient warming products that can help reduce complications and improve patient satisfaction.

"The main benefit of patient warming is the improved SSI rate, which significantly affects the outcome," Matthew Rotterman, vice president of sales for Enthermics said. "Maintaining the body temperature can reduce the rehospitalization rate as well."

In the United States, around 2 to 5 percent of inpatient surgical patients contract an SSI, adding approximately $11,000 to $35,000 to the episode of care per procedure.4 Vancouver General Hospital in Canada was able to reduce SSIs by 77 percent during open heart surgeries by using a five-step process including:

  • Ensuring clean hands
  • Leaving patient dressing on for 72 hours
  • Engaging staff and patients on SSI prevention
  • Using antibiotics appropriately
  • Keeping the patient's body temperature normal
  • Ensuring patients have the appropriate blood glucose level, eats nutritious meals and don't smoke

Patient warming is an integral aspect of providing quality care, but healthcare facilities aren't always designed to warm patients in the most efficient way.

Challenges in traditional patient warming

Hospitals today are re-designing clinical workflow and operations to deliver high quality, cost-effective care to reduce complications, length of stay and readmissions; new approaches to patient warming are a part of these efforts. Historically, hospitals placed blanket and fluid warming cabinets in central locations throughout the building, centralizing the location for the warm fluid and blankets. However, for some operating rooms the blanket and fluid warming cabinets were a significant walk away. As an alternative, surgeons could use in-line warmers to actively warm the fluid, however, associated are disposables adding cost to every case. Blanket and fluid warming cabinets are a permanent option.

Enthermics saw an opportunity to revolutionize patient warming while boosting the quality of care and lowering costs. Instead of relying solely on blanket and fluid warming cabinets, the company designed fluid warming pods that can be stationed at point of care locations as a quick and convenient warming method for the surgical team.

The solution: ivNow

ivNow was designed with the modern operating room and enhanced workflow in mind. The ivNow can produce 20 to 140 liters of warmed fluid in a 12-hour period, automatically warming a 1-liter bag of fluid to 40°C in 30 minutes or less or a 3-liter bag in about 45 minutes. Surgical teams can access the warm fluid without leaving the OR and compromising the sterile environment.

The pods display the exact temperature of every bag and keep the temperature consistent for patient safety. The pods can be placed on a countertop or IV pole to save space in the OR and do not include any disposable components. "ivNow is more cost effective than the standard fluid warming methods because it can eliminate or reduce disposables and typically is sold at a fraction of the price of a warming cabinet," Mr. Rotterman said. Healthcare providers can save thousands of dollars every year by eliminating captive disposables associated with in-line warmers.

The product is also cost-efficient because:

  • Instead of billing for every bag, healthcare organizations can place ivNow next to the medication management system to ensure all bags are accounted for.
  • The ivNow warmers can be placed inside the OR so nurses don't need to leave the room or walk across departments for the warm fluids.
  • ivNow's pod is small and compact, saving space in the OR.
  • The potential for fewer complications, shorter hospital lengths of stay and fewer readmissions also helps providers lower the overall cost of care.

Due to the savings associated with ivNow, hospitals and healthcare providers can realize a return on investment within months of the initial purchase.

Meeting the needs of value-based care

In 2009, The Joint Commission's Surgical Improvement Project developed a guideline around temperature management, stating: "Surgical patients should be actively warmed during surgery or have at least one recorded body temperature equal to or greater than 96.8°F within 30 minutes prior to the end of anesthesia to 15 minutes after anesthesia ends." Without the right tools in place, it's more difficult for the surgical team to meet this requirement. "The fact that ivNow monitors how long the fluids have been warming keeps clinicians informed about the shelf life of the bag and the temperature. This will help them from a regulatory standpoint as it pertains to The Joint Commission or other regulatory bodies," Mr. Rotterman said.

Some reimbursements are now tied to monitoring for complications because of hypothermia. HCAHPS scores monitoring patient satisfaction could also take a hit if patients experience hypothermia symptoms. Patient warming can reduce anxiety, bleeding, anesthesia required to sleep and the risk of cardiac problems, which all significantly improve the overall patient experience.

Successful patient warming can help reduce costs, improve clinical outcomes and safeguard the patient experience. Providers looking to make good on the promise of value-based should consider an innovative approach to patient warming.

References 

1 Rajagopaian S, Mascha E, Na J, Sessler DI. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology. 2008;108(1):71-77

2 Kurz A, Sessler DI, Lenhardt RA Study of wound infections and temperature group: Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med 1996; 334: 1209–15Kurz, A Sessler, DI Lenhardt, R

3 Kurz A, Sessler DI, Lenhardt RA Study of wound infections and temperature group: 
Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med 1996; 334: 1209–15Kurz, A Sessler, DI Lenhardt, R

4 Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999). Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250–278; quiz 279–280. media/pressrel/r2k0306b.htm

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