Staving off hypothermia isn't just about avoiding post-op complications. Maintaining normothermia with warmed blankets, warmed IV fluid or forced-air warming units also helps soothe patients' nerves, leads to increased surgical efficiencies, and plays a part in faster recoveries and timely discharges.

Train your staff to identify patients at increased risk for unplanned perioperative hypothermia — the elderly, women, patients with chronic diseases and decreased immune systems — but don't ignore the overall benefits of a comprehensive warming program, including:

• Reduced anxiety. It's no secret that many patients are anxious when they present for surgery. When patients are nervous, they tense their muscles, which restricts blood flow to the extremities. And when circulation to tissue in the extremities decreases, patients feel colder, tense their muscles more and feel more anxious. It's a vicious cycle that's broken when warming techniques are used; blood vessels in actively warmed patients expand, adequate circulation is maintained and muscle tension is reduced.

During patient warming research conducted at my hospital (see "The Proof Is in the Warming" on page 6), patients said they enjoyed the comfort and privacy offered by a forced-air warming unit's specialized gown and appreciated having control over the unit's temperature setting. They also weren't dependent on nurses to bring over additional warmed blankets. (Patients are sometimes hesitant to interrupt busy pre-op nurses to make the request.) We believe that patients who play an active role in their care are less anxious about the procedures they're about to undergo.

• Easier IV starts. Maintaining adequate circulation in the extremities also helps during IV starts. Pre-op nurses typically wrap a patient's arm in a warmed blanket to increase blood flow and expand target veins, making them more visible below the skin's surface. In fact, some of the specialized gowns used in conjunction with forced-air warming units are designed with slits in the front where patients can stick their arms for warming immediately prior to the IV start.
• Staff efficiencies and savings. Our patient warming research included a cost-comparison of forced-air warming units and warmed blankets. We first examined laundry costs when analyzing the expenses associated with warmed blankets. It costs us 78 cents to launder 1 blanket and 45 cents to launder a single patient gown. Since we use an average of 10 blankets per patient (and a single gown), we spend $8.37 to clean the linens used on individual patients. (That figure also includes a portion of our hospital's $3 daily linen delivery charge.)

We also estimated that 5 minutes tick away each time a nurse removes a cooled blanket from the patient, tosses it in a soiled laundry bin, retrieves a warmed blanket and returns to the patient. If you consider that the average perioperative nurse makes $35 per hour, the time spent applying and reapplying warmed blankets costs $2.90 per patient during their entire stay. So to maintain normothermia in a single patient using warmed blankets costs approximately $11.27 ($8.37 + $2.90) in laundry and staff expenses.

On the other hand, the disposable gowns used with a forced-air warming unit cost $10.50 (a one-time fee). We estimated that nurses deliver and apply the gowns in approximately 1 minute — performed once and in less time than it takes to replace a cooled blanket — which results in a staffing cost of 58 cents per patient. Forced-air warming therefore costs $11.08 per patient — or 19 cents less than warmed blankets. That might not seem like much of a difference, but it results in approximately $1,235 in annual savings if forced-air warming is used on an average of 25 patients a day. At the very least, we discovered that employing forced-air warming is no more expensive than using warmed blankets.

• Faster discharges. In my experience, warmed patients are more likely to be discharged on time. Anesthesia constricts the blood vessels, which, as previously mentioned, limits blood flow to the extremities. That, in turn, increases shivering and the sensation of being cold, even if core body temperatures are well within the range of normothermia. A patient who feels cold or thinks he's cold isn't easily convinced to ready himself for discharge. In addition, research has shown that warmed patients report less post-op pain, another essential factor in maintaining efficiencies in the PACU.

Happy patients, happy staff
From a patient satisfaction standpoint, the advantages of incorporating effective warming protocols into your preoperative routines are obvious. What's not so obvious is how much patient comfort factors into the overall efficiency of your surgical services. Whatever method you use to warm patients properly, your surgical output is bound to heat up.