Cooling Blankets in Hospitalized Patients: Time to Reevaluate.

BACKGROUND: The therapeutic benefits and rationale for treating fevers with external cooling methods remain unclear. We aimed to describe the clinical settings in which cooling blankets (CBs) are used. DESIGN: We conducted a retrospective chart review of CB use in adult patients admitted to our tertiary care center over a one-year period. We measured how they are used and correlations between clinical variables and their duration of use. RESULTS: 561 patients were included in our study. The mean highest temperature during hospitalization was 39.35 °C (SD, 0.67). Shivering occurred in 176 patients (31.4%) while on a CB although 303 patients (54%) had no data regarding shivering. Discontinuation of CBs was recorded in only 177 (30.5%) cases. Among these, the median duration of use was 33.37 h (IQR: 18.13-80.38) while the median duration of fever was 22.13 h (IQR 6.67-51.98). Duration of CB use was highly correlated with fever duration (Spearman's rho, 0.771, p < .001), moderately with length of stay (LOS) (rho, 0.425, p < .001), LOS after CB initiation (rho, 0.475, p < .001) and antipyretic use (rho, 0.506, p < .001). No other statistically significant correlations were observed. CONCLUSION: Documentation of CB use including temperature set points, time of discontinuation and duration in EMRs was poor. We could not establish benefits of CB use in this study but observed that almost a third of patients developed adverse effects in the form of shivering. Thus, adverse effects of CB use may outweigh potential benefits. Their use should be reevaluated and institutional protocols developed for their use.

Reengineering the patient's environment: Establishment of a "Red Box" to improve communications with patients on isolation precautions.

BACKGROUND: Hospitalized patients on isolation precautions are reported to have less frequent health care provider (HCP) visits owing to time required to don and doff personal protective equipment (PPE). Thus, placement on isolation precautions leads to negative patient perception and affects their care. METHODS: A "Red Box" that extended 3 feet beyond the door was marked in 50 patient rooms of a tertiary care hospital and used for patient communication by HCPs without PPE. HCP and patient perceptions of the Red Box were studied via a survey and personal interviews. Compliance was also observed by "secret shoppers." Rates of health care-associated infections (HAIs) were monitored. RESULTS: Over a 1-year period, HCPs reported improved patient communication, utilization of time, and increased interactions. HCPs used the Red Box to communicate with patients 76% of the time. In 92% of the cases, HCPs remembered not to use PPE while in the Red Box and were observed 80% of the time using PPE when venturing beyond the Red Box. Patients reported improved frequency of HCP contact and satisfaction. HAIs in these units did not show any increase compared with those in prior years. CONCLUSIONS: HCP interaction and communication with patients on isolation precautions improved with the reengineering of the patient environment in the form of the Red Box. HAI rates did not increase with this intervention.