Children lose heat quickly in the operating room. They have a large body surface area for their size, and anesthesia blunts the body's normal response to cold. Postoperative hypothermia is linked to wound infection, bleeding, and slower recovery, so it's a problem every pediatric anesthesia department cares about.
A few years ago our department's postoperative hypothermia rate was about 9%. Everyone knew how to warm a patient. The warming blankets, fluid warmers and room temperature controls were already there. The gap was in doing it consistently, case after case, across more than 30 attendings.
Start with motivation, not mandates
We built the project around self-determination theory, which says people are most motivated when three needs are met: autonomy, competence and relatedness. In practice that meant:
- Autonomy. We didn't hand down a rigid checklist. We shared the evidence and the data, and let each anesthesiologist decide how to apply it in their own cases.
- Competence. Each attending could see their own hypothermia rate, their warming device use and their case mix, compared with the department. Most of us had never seen our own numbers before.
- Relatedness. A committee met regularly, presented results to the whole department every month, and treated the project as a shared goal rather than an audit.
Participation also counted toward continuing medical education, which gave busy clinicians a concrete reason to engage.
What happened
The rate fell from 9% to 2%, and it stayed down. We published the work in the Journal of Clinical Outcomes Management in 2021, and the poster won third place at the 2020 ASA and Anesthesia Patient Safety Foundation meeting.
What I'd tell another department
- Make the data personal. Department averages are easy to ignore; your own numbers aren't.
- Present results often. Monthly updates kept the project visible long after the launch.
- Give people room to choose how they get there. Ownership lasts longer than compliance.
- Plan for after the project. The point is a new habit, not a temporary spike.
If your team is working on temperature management, or any perioperative measure that has stalled, I'm glad to talk it through. You can reach me through the contact page.