561. Accuracy of Surgical Care Improvement Project (SCIP) Metrics for Documenting Normothermia
Session: Oral Abstract Session: Advancing Public Reporting and Surveillance of HAIs
Thursday, October 3, 2013: 2:45 PM
Room: The Moscone Center: 200-212
Background: Current SCIP criteria for normothermia include use of active warming devices, or achieving a temperature of >36.0 C within 30 min before or 15 min after the end of anesthesia.

Objective:  To evaluate the accuracy of SCIP normothermia criteria for confirming intraoperative normothermia in patients undergoing abdominal surgery. 

Methods: Electronically recorded intraoperative patient temperatures (temps), obtained every minute by esophageal probes in patients undergoing abdominal procedures, were obtained for 321 procedures performed in November 2012 at a university hospital. Records for 50 consecutive procedures from each of 3 operating pavilions (150 of the 321 procedures) were reviewed. The first 5 temps for each procedure were omitted to allow time for temperature probe equilibration. Procedures with fewer than 20 temps were excluded. For each procedure, the proportion of intraoperative temps < 36.0 C (hypothermia), temps < 35.5 C, nadir temp of < 35.0 C and whether the procedure met any of the SCIP normothermia metrics were determined.  Temps in the post-operative acute care unit (PACU) were obtained by the infrared temporal artery method

Results: Only 26 (17.3%) of procedures had all intraoperative temps > 36.0 C. 71 (47.3%) had > 1 temp < 36.0 C, 34 (22.7%) had all temps < 36.0 C with some temps > 35.5 C, and 19 (12.7%) had all temps < 35.5 C.  Esophageal temp probes were used for 89% of the 53 (35.3%) patients who were hypothermic (< 36.0 C) on all intraoperative temp recordings.  22 (41.5%) of these 53 patients had nadir temperatures < 35.0 C. Fifty-two (98.1%) of the 53 procedures with all intraoperative temps < 36.0 C met one or more SCIP criteria for normothermia; 46 (87%) had warming device used and 42 (79%) had temp > 36.0 C within 15 min of end of anesthesia.   Limitations include the small sample size and lack of data regarding accurate positioning of esophageal temp probes.

Conclusion: This study suggests that current SCIP criteria do not accurately reflect achievement of or maintenance of normothermia during abdominal surgery.  Further studies with validated temp monitoring procedures are needed to re-evaluate SCIP criteria for normothermia.

John M. Boyce, MD, FIDSA1,2, Linda Sullivan, RN1, Douglas Vaughn, MD3,4 and Kimberly A. Davis, MD, MBA5,6, (1)Quality Improvement Support Services, Yale-New Haven Hospital, New Haven, CT, (2)Medicine, Yale University School of Medicine, New Haven, CT, (3)Anesthesiology, Yale University School of Medicine, New Haven, CT, (4)Dept. of Anesthesia, Yale-New Haven Hospital, New Haven, CT, (5)Surgery, Yale University School of Medicine, New Haven, CT, (6)Surgery, Yale-New Haven Hospital, New Haven, CT

Disclosures:

J. M. Boyce, None

L. Sullivan, None

D. Vaughn, None

K. A. Davis, None

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