Closing the Perioperative Temperature Gap: Lessons from Implementation Science

Busy clinicians are faced with a constantly expanding body of published literature.The wealth of evidence available to improve patient outcomes and health system efficiency is enormous and growing.The prospect of applying best practice based on a mass of data, even with consensus of certain themes, is usually characterized by significant delays from bench to bedside.Most published data will not achieve widespread adoption.When scientific evidence does make the transition to practice improvement the lag between generating evidence and routine clinical use is estimated to be 17 years. 1ddressing this evidence-to-practice gap is the primary focus of implementation science.The evidence-to-practice gap is not merely academic.Experienced clinicians can typically cite examples of fundamental safety practices that fail to occur reliably in their institutions.Perioperative temperature management is a case in point.A period-prevalence study of five Australian hospitals (1,690 surgical patients) observed that more than half of the patients had just two or fewer temperature measurements during the entire surgical pathway. 2 Notably no temperature was recorded at any stage before the Post-Anaesthetic Care Unit (PACU) arrival in one third of patients.In PACU, temperature monitoring was near-universal but in many ways not soon enough, with approximately one third of patients unintentionally hypothermic post-operatively.This is the "perioperative temperature gap".Guidelines and devices are at hand, yet systems fail to deliver routine, risk-aligned warming and monitoring that would benefit our patients and healthcare systems.