A clinical audit cycle of post-operative hypothermia in dogs

Abstract

Objectives: Use of clinical audits to assess and improve perioperative hypothermia management in client-owned dogs. Methods: Two clinical audits were performed. Audit 1: data were collected to determine the incidence and duration of perioperative hypothermia (defined rectal temperatures < 37.5˚C). The results from Audit 1 were presented to clinic staff and a consensus reached on changes to be implemented to improve temperature management. Following one month with the changes in place, Audit 2 was performed to assess performance. Results: Audit 1 revealed a high incidence of post-operative hypothermia (88.9%) and prolonged time periods for animals to reach normothermia. Following discussion, a consensus was reached to: 1. measure rectal temperatures hourly post-operatively until a temperature ≥ 37.5˚C was achieved and 2. use a forced air warmer on all dogs until rectal temperature was ≥ 37˚5. After one month with the implemented changes, Audit 2 identified a significant reduction in the time to achieve a rectal temperature of ≥ 37.5˚C, with 75% of dogs achieving this goal by 3.5 hours (7.5 hours for Audit 1, p = 0.01). The incidence of hypothermia at extubation remained high in Audit 2 (97.3% with a rectal temperature < 37.5˚C). Clinical significance: Post-operative hypothermia was improved through simple changes in practice, showing that clinical audit is a useful tool for monitoring post-operative hypothermia and improving patient care. Overall management of perioperative hypothermia could be further improved with earlier intervention.

Applying clinical audit for quality improvement in canine dystocia cases seen at a UK primary‐care emergency practice

“…Therefore, exploring the capabilities of the practice management system is an important part of the planning phase. Pilot audits are recommended as iterative exercises prior to implementation of an audit to identify areas for further consideration and mitigation 19 . Using the electronic patient record to extract data has limitations, but is an effective way to access cumulative clinical experience of a large group of practitioners, offering insight into current established practice 43 .…”

“…A recent systematic review on clinical audit in small animal veterinary practice cites the development of explicit criteria and the recurring cyclical nature of the audit process as key audit principles that are often unfulfilled; without these, most efforts towards ‘clinical audit’ are simply one‐off surveys of practice 19 . In the current audit, there was a paucity of previous high‐quality published evidence on managing dystocia in primary‐care practice.…”

“…During the planning phase of a clinical audit, important factors to consider include topic selection relative to available data collection tools, how to overcome common barriers such as limited existing published standards and how to encourage staff to engage with improving standards of care. 19 Largescale data collection in primary-care practice often relies on the functionality of the internal practice management system, searching for chargeable related items, searchable protocols or using clinical coding to provide the relevant data. 42 Therefore, exploring the capabilities of the practice management system is an important part of the planning phase.…”

“…In the veterinary literature, uptake of clinical audit has been slower and less widespread 19 . Barriers to success of the clinical audit process in veterinary medicine have been reported to include weak project design, use of a variety of reporting methods, which may reduce visibility of published audits, and a paucity of veterinary evidence‐based guidelines to support benchmarking against explicit criteria 7,19,20 .…”

“…19 Barriers to success of the clinical audit process in veterinary medicine have been reported to include weak project design, use of a variety of reporting methods, which may reduce visibility of published audits, and a paucity of veterinary evidence-based guidelines to support benchmarking against explicit criteria. 7,19,20 Additionally, as reported in human healthcare, limited resources, limited expertise or advice, dysfunctional relationships between group members, lack of an overall plan and perceived lack of management support may contribute to poorly effective veterinary clinical audit processes. 21 While the process of clinical audit is intended as an iterative cyclical activity, assessing the impact of changes by repeating data collection phases is often missed.…”