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Documentation of Core Temperature in Pediatric Patients Undergoing General Anesthesia: A Quality Improvement
Alexandra C Cates1, Bradley J Curtis1, Christy J Crockett1
1Department of Anesthesiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Insights
This quality improvement initiative successfully increased documented core temperature monitoring in pediatric dental surgery patients from 10% to 90%. This enhances patient safety by addressing perioperative hypothermia risks during general anesthesia.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Quality Improvement Science
Background:
- Pediatric patients are vulnerable to heat loss during anesthesia due to thermoregulatory inhibition.
- Perioperative hypothermia poses risks, necessitating core temperature monitoring in pediatric surgical patients.
- A quality improvement initiative was implemented to improve core temperature monitoring documentation.
Purpose of the Study:
- To increase documented core temperature monitoring in pediatric patients undergoing general anesthesia in a dental operating room.
- To achieve a target of 60% documented core temperature monitoring by October 2023.
Main Methods:
- Utilized the Model for Improvement framework with Plan-Do-Study-Act cycles.
- Implemented interventions including educational emails, signage, a Morbidity and Mortality Conference, and electronic health record pop-up reminders.
- Focused on pediatric patients undergoing general anesthesia for over an hour in the dental operating room.
Main Results:
- Documented core temperature monitoring increased from 10% to 60% by October 2023.
- Further increased to 90% compliance by January 2024.
- Successfully met and exceeded the quality improvement initiative's aim.
Conclusions:
- The quality improvement initiative effectively enhanced compliance with core temperature monitoring guidelines.
- Achieved a 90% rate of documented core temperature monitoring for eligible pediatric patients by January 2024.
- Demonstrated successful implementation of interventions to improve patient safety during pediatric anesthesia.
Background:
Children's body composition makes them highly susceptible to heat loss, which is further amplified by anesthetic-induced inhibition of thermoregulatory control. Perioperative hypothermia can lead to adverse outcomes, thus highlighting the importance of core temperature monitoring for pediatric patients undergoing general anesthesia. We launched and completed a quality improvement (QI) initiative at our institution starting in February 2023, with the SMART aim to increase the percentage of pediatric patients in our dental OR who receive a documented core temperature in the anesthetic record from 10% to 60% by October 2023.
Methods:
We referenced the Standards for Quality Improvement Reporting Excellence guidelines and used the Model for Improvement with interventions tested via Plan-Do-Study-Act cycles. We tested 5 interventions between February and October 2023. These included an educational email to all anesthesia professionals, a posted sign in the OR, a Morbidity and Mortality Conference regarding core temperature monitoring, and the development of an integrated pop-up reminder to measure core temperature in our electronic healthcare record.
Results:
With this QI initiative, the percentage of pediatric patients undergoing general anesthesia for more than an hour in our dental OR with documented core temperature monitoring increased from 10% to 60% by October 2023, and to 90% by January 2024.
Conclusions:
We successfully increased compliance with standard ASA monitoring guidelines. By January 2024, 90% of pediatric patients undergoing general anesthesia for more than an hour in our dental OR had documented core temperature monitoring in the anesthetic record.
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