Implementing and evaluating a low-carbon, high-quality perioperative patient warming pathway

Area of Science:

• Perioperative Medicine
• Environmental Sustainability in Healthcare
• Quality Improvement in Surgery

Background:

• Intraoperative hypothermia presents significant clinical, financial, and environmental challenges.
• Environmentally preferable warming practices include reusable blankets and optimized use of forced air warming (FAW) garments.
• An optimized patient warming pathway (OPWP) was developed by integrating environmental data with best practices.

Purpose of the Study:

• To develop and evaluate an optimized patient warming pathway (OPWP) for reduced environmental impact and improved patient care.
• To integrate environmental data, best practices, and quality improvement methodologies into a sustainable perioperative warming strategy.
• To assess the impact of the OPWP on environmental savings, financial costs, hypothermia rates, and patient-reported outcomes.

Main Methods:

• The OPWP was developed through a scoping review, environmental impact assessment, and root cause analysis.
• Implementation involved nine Plan-Do-Study-Act (PDSA) cycles at a tertiary care hospital, including expanded pre-warming, FAW garment preservation, staff education, and behavioral strategies.
• Pre- and post-intervention audits evaluated environmental and financial savings, hypothermia incidence, and patient-reported outcomes.

Main Results:

• Flannel blanket use decreased significantly (6 to 3 per patient; p<0.01) post-implementation.
• Active warming rates increased preoperatively (55% to 80%; p=0.04) and postoperatively (0% to 55%; p<0.01).
• Annual savings estimated at 940,339 kg CO2 equivalents and $C117,978, with no significant change in hypothermia (18% to 15%; p=0.77) and favorable patient-reported outcomes.

Conclusions:

• The evidence-based OPWP successfully achieved environmental sustainability and low-carbon patient care.
• Implementation demonstrated significant environmental and financial benefits while maintaining high-quality patient care.
• The pathway offers a model for sustainable perioperative warming practices in healthcare settings.