Title : Keeping warm, healing strong: A multidisciplinary quality improvement initiative to reduce intraoperative hypothermia in burn surgery patients
Abstract:
Background: Burn patients are uniquely vulnerable to hypothermia due to impaired thermoregulation, high evaporative heat loss, and frequent exposure of large surface areas during surgery. Intraoperative hypothermia increases risks of coagulopathy, blood loss, delayed wound healing, and prolonged hospitalization. A 2024 review at a large academic Midwest Hospitals burn unit identified that 51.6% of burn surgeries involved at least one intraoperative temperature below 36.0°C, revealing a significant opportunity to improve surgical safety in this high-risk population.
Purpose: The aim of this quality improvement project was to reduce the incidence of intraoperative hypothermia among burn surgery patients by 50%—from 26% to 13%—by November 30, 2025. Long-term, the project seeks to eliminate hypothermia across all pre and perioperative phases.
Methods: A multidisciplinary team of nursing, surgery, anesthesia, and perioperative services conducted structured observations, process mapping, and a key driver analysis. Major gaps included inconsistent warming protocols, lack of pre-operative warming procedures, age-inappropriate warming devices, equipment variability, and OR rooms not warmed due to work-order delays. Documentation inconsistencies and low staff awareness further contributed to preventable hypothermia. Interventions targeted five key drivers: (1) effective temperature monitoring, (2) staff knowledge and engagement, (3) reliable access to age-appropriate warming equipment, and (4) standardization of evidence-based warming processes (5) advanced risk identification and appropriate clinical reactions.
Interventions included:
- Standardizing pre-op, pre-induction, intra-op, and post-op temperature documentation
- Implementing pre-operative warming procedures and burn-specific warming SWIs
- Standardizing OR room warming and device selection
- Introducing an endotracheal warming device for high-risk patients
- Developing an EPIC-embedded risk stratification tool based on TBSA, age, weight, and history
- Weekly temperature audits and real-time feedback to OR teams
- Staff education, visual reminders, and workflow redesign to ensure reliable warming practices
Results: Consistent application of key interventions improved process reliability across perioperative stages. Early data demonstrated reductions in hypothermia among short-duration cases, the group with the highest baseline risk, and improved compliance with temperature documentation standards. Real-time OR audits revealed increased use of correct warming devices and improved readiness of warmed IV fluids, with enhanced interdisciplinary communication around temperature trends. Further stratified analyses by case duration, age group, and burn size are underway to refine risk-targeted interventions and guide future implementation of advanced warming technologies. Through various interventions have been able to decrease the hypothermia rate by 30% as well as identification of new risk factors to be utilized for more advanced interventions.
Conclusion: This project demonstrates that structured, multidisciplinary quality improvement efforts can significantly reduce intraoperative hypothermia in burn surgery patients. Early outcomes highlight the effectiveness of combining standardized warming protocols, EMR optimization, risk stratification, and staff engagement. Continued monitoring, data refinement, and expansion to inpatient pre-operative workflows will support sustainability and inform best practices for burn centers nationally.
