The Impact of Shared Governance: Implementing Preoperative Warming to Improve Postanesthesia Outcomes Among...

Unintentional perioperative hypothermia (PH), a core body temperature below 36°C, is a common and preventable complication leading to adverse outcomes. While Enhanced Recovery After Surgery (ERAS) protocols and professional guidelines recommend preoperative warming measures, particularly forced-air warming (FAW), implementation remains inconsistent. In response to observations of inconsistent preoperative normothermia interventions, a multidisciplinary team utilized a shared governance (SG) model to drive an evidence-based practice (EBP) change.

The aim of this EBP project was to evaluate the impacts of implementing a standardized preoperative FAW protocol for adult patients undergoing elective gynecological surgery.

Guided by the IOWA model, this EBP project was conducted from March 2025 to January 2026 in a mid-size military healthcare facility by the Paranesthesia Unit Practice Council.

A post-implementation group (n = 30) of gynecology patients who received 20 minutes of preoperative FAW was compared to a historical pre-implementation control group (n = 19). Patient outcome measures include preoperative and postoperative temporal temperature, PACU length of stay (LOS), number of pain medication doses, shivering (4-point scale), and thermal comfort (5-point scale). Data analysis used descriptive statistics to analyze pre- and post-implementation patient outcome data. Human Protection Officer reviewed and determined the project as non-research.

The FAW protocol produced a meaningful reduction of average PACU LOS by 12.2 minutes, while no clinically significant differences were observed in postoperative temperature, pain medication doses, shivering, or thermal comfort. When controlling for patient outliers, the mean PACU LOS was further reduced by 24.3 minutes compared to the pre-implementation group. This decrease corresponds to a potential institutional cost avoidance of over $50,000 annually for this patient population.

This EBP project demonstrates that preoperative FAW, implemented through shared governance, can be an effective strategy for decreasing PACU LOS in gynecology patients. The findings underscore the critical role of shared governance and the value of empowering frontline nurses to drive evidence-based practice changes to improve perioperative patient care and organizational performance.