SIGH AND SMILE Nothing impacts a patient's emotional and physical well being like being kept warm.

You value patient warming for its clinical utility, for its ability to maintain core temperature and reduce perioperative hypothermia. Your patients? They probably don't know what those words mean, much less care. Not when it's freezing cold in the OR and they're shivering and their teeth are chattering. That sigh of relief you hear and that smile you see when you actively warm them is all you need to know that you've made a most lasting and positive impression on their emotional and physical well-being. When I was cold, you warmed me.

"Most patients just want to wake up as warm as they were when they were drifting off to sleep," says Darren Long, CRNA, MSN, of Avita Health System in Galion, Ohio.

If improving patient satisfaction scores and delivering patient-centered care are high on the list of priorities at your facility, practitioners we talked to say you should actively warm every patient.

"From a 5-minute case to a 2-hour case and everything in between," says Thomas W. Durick, MD, medical director and staff anesthesiologist at the Bay Surgery Center in Oakland, Calif., where they keep the 2 ORs a cool 60 ? F. "There's no risk and all the benefits. How can you not do it?"

Yes, it's comforting and reassuring to be warm when you're put to sleep and such a relief not to wake up shivering. But if increasing patient satisfaction isn't enough reason for you to actively warm, there are irrefutable positive patient outcomes to be gained by preventing hypothermia, from faster discharge to reduced post-op pain and blood loss to fewer surgical site infections. "All sorts of bad things happen from being cold," says James H. Philip, ME(E), MD, CCE, an anesthesiologist at Brigham and Women's Hospital in Boston and a professor of anesthesia at Harvard Medical School.

Brigham and Women's has had a universal warming policy since the mid-90s. As soon as a patient enters the OR, he's fitted with 3 devices: warming gown, pulse oximeter and blood pressure cuff. "It is the first thing we do," says Dr. Philip. "I haven't seen more than one patient shiver since we started our policy. I don't have any good measures of patient satisfaction, but I know that every one of them says thank you and every one wakes up saying he or she is warm and comfortable."

Thermal comfort
Sue Seitz, MSN, RN, CNS, CNOR, calls that feeling thermal comfort — the psychological state of the human mind that is satisfied with the temperature of the environment. It's what happens when you've properly warmed a patient throughout the perioperative process. Ms. Seitz, a clinical practice specialist at Bon Secours St. Francis Hospital in Greenville, S.C., theorizes that when a patient is able to control his physiological response to a frigid OR, he's likely to be in less pain. "When you're anxious, you're usually cold," she says. "If a patient has more thermal comfort in post-op, there might be a decreased use of narcotics."

Theresa Criscitelli, EdD, RN, CNOR, assistant director of professional nursing practice and education at Winthrop University Hospital in Mineola, N.Y., puts it simply. "Most often, we look towards the very technical and medically based ideas, but maybe it is much simpler than that. What about simply having more control over the environment and providing thermal comfort to the surgical patient?"

While there's little research about patient thermal comfort, it's clear that temperature is an integral component of a patient's perception of well-being during the perioperative experience, according to "Effects of comfort warming on preoperative patients," a 2006 study in the AORN Journal.

"When patients look back upon their surgical stay, the surgical experience includes the feelings of thermal comfort or possibly discomfort," says Ms. Criscitelli. "These feelings will have an effect on the patient's overall satisfaction of the hospital experience. Providing passive and active forms of warming, especially ones that are controlled by the patient, can enable the patient to associate comfort with the surgical experience."

Mr. Long says many of his patients have described how their uncontrollable shivering in the recovery room that seems to last forever actually hurt more than their surgical incisions. "Most patients only remember waking up in the PACU, not the OR, so we take that opportunity to get them warm blankets immediately prior to transport," says Mr. Long. "Immediately hooking them back up to the warmer in PACU is also a priority. I notice patients will sometimes complain of more post-operative pain if they are also cold. Appropriate pain control, absence of nausea and a comfortable post-operative temperature adds up to a very satisfied patient."

The 'Sevo Shake'
Mr. Long warns of an "almost unbearable" combination for patients: a cold OR coupled with sevoflurane or desflurane, 2 inhalational agents that have been linked to post-op shivering. "During my anesthesia training, we learned it as the 'Sevo Shake,' especially when we would use LMAs and pull them deep." When the patient is spontaneously breathing with an adequate airway but has higher residual levels of the agent in his system, he continues to breathe it off in PACU while waking up, says Mr. Long. "Combine this high residual agent with a low core body temperature, and you'll sometimes see the 'Sevo Shake,'" he says.

Sterile instruments and skilled surgeons matter, but so do the most basic needs. "Patients just want to be warm and comfortable," says Fawn Esser Lipp, RN, BSN, CNOR, the chief clinical officer at The Surgery Center in Franklin, Wis.