• Qianqi Qiu, Zixin Yang, Yong Zhang, Wen Zeng, Kuiyan Yang, Cuiping Liang, Ailixiati Alifu, Haibo Huang, Jun Chen, Meixue Zhang, Dongmei Wu, Xiaoping Guo, Saifen Jin, Yuzhen Lin, John Chuo, Huayan Zhang, Xingrong Song, and Rajeev S Iyer.
• Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
• Paediatr Anaesth. 2024 Aug 1; 34 (8): 773782773-782.

BackgroundUnintended postoperative hypothermia in infants is associated with increased mortality and morbidity. We noted consistent hypothermia postoperatively in more than 60% of our neonatal intensive care (NICU) babies. Therefore, we set out to determine whether a targeted quality improvement (QI) project could decrease postoperative hypothermia rates in infants.ObjectivesOur SMART aim was to reduce postoperative hypothermia (<36.5°C) in infants from 60% to 40% within 6 months.MethodsThis project was approved by IRB at Guangzhou Women and Children's Medical Center, China. The QI team included multidisciplinary healthcare providers in China and QI experts from Children's Hospital of Philadelphia, USA. The plan-do-study-act (PDSA) cycles included establishing a perioperative-thermoregulation protocol, optimizing the transfer process, and staff education. The primary outcome and balancing measures were, respectively, postoperative hypothermia and hyperthermia (axillary temperature < 36.5°C, >37.5°C). Data collected was analyzed using control charts. The factors associated with a reduction in hypothermia were explored using regression analysis.ResultsThere were 295 infants in the project. The percentage of postoperative hypothermia decreased from 60% to 37% over 26 weeks, a special cause variation below the mean on the statistical process control chart. Reduction in hypothermia was associated with an odds of 0.17 (95% CI: 0.06-0.46; p <.001) for compliance with the transport incubator and 0.24 (95% CI: 0.1-0.58; p =.002) for prewarming the OR ambient temperature to 26°C. Two infants had hyperthermia.ConclusionsOur QI project reduced postoperative hypothermia without incurring hyperthermia through multidisciplinary team collaboration with the guidance of QI experts from the USA.© 2024 John Wiley & Sons Ltd.

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