The GLOW Trial: implementing Guidelines for hypothermia prevention with Local adaptation to keep periOperative patients Warm.

INTERVENTION: Intervention ‐ implementation of perioperative hypothermia prevention principles and practice recommendations supported by internal and external facilitation. During a 6‐month implementation transition period, local adaptation and implementation of the principles and practice recommendations will commence. Each cluster (perioperative department) will be provided with internal and external facilitation support for implementation of perioperative hypothermia recommendations comprising of 1. Simple principles for perioperative hypothermia prevention; 2. Supporting detailed practice recommendations. The recommendations comprise of the three domains of hypothermia prevention: (1) monitoring temperature, (2) warming actively, (3) minimising exposure. Examples of the practice recommendations include: (1) Monitoring Temperature ‐ Actively monitoring temperature for all patients at all times; (2) Warm Actively ‐ warm actively to keep temperature above 36°C; (3) Minimise Exposure ‐ minimise exposure to cold at all stages of perioperative care. Intervention ‐ Implementation Strategy The core components of the implementation strategy are 1. a team‐based approach to implement the recommendations with local adaptation; 2. expert facilitation and structured support. Each cluster (perioperative department) will form a Site Implementation Team including registered nurses, anaesthetists and surgeons. Internal facilitation will be provided within each department by a Registered Nurse. External facilitation is provided by the research team. The Site Implementation Teams will adapt the recommendations, according to context, while working through an implementation process that is guided by the Knowledge‐to‐Action framework. External facilitators will support internal fac CONDITION: Anaesthesiology ‐ Other anaesthesiology Perioperative hypothermia (defined as a body temperature less than 36°C related to undergoing surgery); ; Perioperative hypothermia (defined as a body temperature less than 36°C related to undergoing surgery) Public Health ‐ Health service research Surgery ‐ Other surgery PRIMARY OUTCOME: Perioperative hypothermia (defined as a temperature less than 36°C) ‐ assessed via health record review. [On arrival to Post Anaesthetic Care Unit (PACU).] SECONDARY OUTCOME: Blood product transfusions, assessed via health record. [From surgical start time to discharge post‐surgery. ] Cost‐effectiveness of intervention, as assessed via Quality of Life measures (via EQ‐5D‐DL), estimated staff time spent on implementation activities (via activity logs), hospital bed days and admission costs (as determined from hospital records), and unplanned admissions (as determined from hospital records). [At end of trial. ] Implementation context: assessed via survey using Organisational Readiness for Change tool. [During month 1 of six‐month transition period] Implementation outcome: actual adoption of practice recommendations assessed via structured survey, designed specifically for this study. [At end of transition period. ] Implementation outcome: actual implementation of practice recommendations (monitoring temperature, active warming, minimising exposure) ‐ assessed via hospital records. [Throughout intervention period. ] Implementation outcome: actual implementation strategy use assessed via activity logs.[At end of transition period.] Implementation outcome: implementability of intervention assessed using a survey incorporating validated tools, using Likert scales, to assess intervention acceptability, feasibility and appropriateness (Weiner et al. 2017) and structured response options incorporating questions from the validated CAPGO questionnaire ( Brouwers et al.2009) adapted for use in the perioperative context. [During month 1 of six‐month transition period, at end of transition period.] Implementation outcome: site implementation capacity assessed via via a study‐specific survey incorporating the validated Implementation Climate Scale (Ehrhart et al 2021).[During month 1 of transition and end of transition period. ] Implementation outcome: site implementation team experience via a study‐specific survey incorporating questions using Kirkpatrick's levels of training evaluation (Kirkpatrick 2016). [During month 1 and at end of transition period. ] Implementation outcome: site implementation team learning via a study‐specific survey incorporating the validated Practicing Knowledge Translation too (Moore et al. 2018) [During month 1 of transition and end of transition period. ] Indication for unplanned admissions, as assessed via hospital records, and as per Australian Commission for Safety and Quality in Health Care definition.[At 28 days post‐discharge. ] Length of hospital stay (in days), defined as days of separation and assessed via admitted hospital data records. [Length of stay from admission to discharge. ] Patient‐reported quality of life, as assessed via EQ‐5D‐DL [Baseline (preoperative ‐ within 48hours prior to surgery) ; At postoperative Day 2 ; At postoperative Day 30] Perioperative hypothermia (defined as a temperature less than 36°C) ‐ assessed via health record review. [Within hour prior to surgery; on induction; Intraoperatively ‐ from anaesthetic induction to end of surgery; during PACU admission (any temperature checks); on ready to discharge from PACU.] Post Anaesthetic Care Unit length of stay (in hours) assessed via health record. [Post Anaesthetic Care Unit discharge. ] Surgical site infection, as assessed by health records and hospital reports. [On discharge from episode of care. ; At 30 days post‐surgery. ] Surgical site infection, as assessed via Bluebelle self‐report wound healing validated survey. [At 30 days post‐discharge from surgery. ] Unplanned admissions, as assessed via hospital records, and as per Australian Commission for Safety and Quality in Health Care definition.[At 28 days post‐discharge. ] INCLUSION CRITERIA: Patient participants: Adults aged 16yrs or older having undergone general or neuraxial, elective or emergency surgery at the hospital site during the site's control or intervention period will be eligible for inclusion. A random sample of patients undergoing elective surgery will be approached prior to surgery to participate in the collection of data for patient‐reported outcomes (Quality of Life, self‐reported wound healing) in addition to clinical outcomes collected for the main study. Clinicians: For the implementation outcomes, clinicians will be included in implementation evaluation surveys if they have been involved in the Site Implementation Team (including registered or enrolled nurses, anaesthetic technicians, surgical and anaesthetic medical personnel). In addition, any clinician working in the perioperative department including registered or enrolled nurses, anaesthetic technicians, surgical and anaesthetic medical personnel) during the study period w