Frequency and Appropriateness of Fasting Orders in the Hospital

Sorita, Atsushi; Thongprayoon, Charat; Ahmed, Adil; Bates, Ruth; Ratelle, John T.; Rieck, Katie M.; Devalapalli, Aditya P.; Issa, Meltiady; Shah, Riddhi M.; Lalama, Miguel A.; Wang, Zhen; Murad, M. Hassan; Kashiwagi, Deanne T.

doi:10.1016/j.mayocp.2015.07.013

Cited by 32 publications

(24 citation statements)

References 43 publications

(35 reference statements)

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“…Hypotheses for why NPO status is inappropriately prolonged include the failure of some clinicians in adopting evidence base guidelines and a "just in case" attitude. [22] Better education of the clinical team on pre-procedure fasting guidelines may help mitigate prolonged nil per os. [13,[22][23][24] Due to the unique nature of our study, there is limited ability to compare our findings with previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…[22] Better education of the clinical team on pre-procedure fasting guidelines may help mitigate prolonged nil per os. [13,[22][23][24] Due to the unique nature of our study, there is limited ability to compare our findings with previous studies. Additionally, due to limited resources, our study had a small sample size and therefore lack of association between readmission and gaps in care may be due to type 2 error.…”

Section: Discussionmentioning

confidence: 99%

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Impact of gaps in care for malnourished patients on length of stay and hospital readmission

Ringel

Jannat‐Khah

Chambers

et al. 2019

BMC Health Serv Res

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BackgroundFew published articles have focused on identifying the gaps in care that follow a malnutrition diagnosis and their effects on length of stay (LOS) and 90-day readmission. We hypothesized that length of stay and readmission were associated with these gaps in care.MethodsTwo registered dietitians retrospectively reviewed charts of 229 adult malnourished patients admitted to a medicine unit to determine their system level gap in care: communication, test delay, or discharge planning. In this secondary analysis, both readmission and length of stay were regressed on each gap in care.ResultsAny system level gap was associated with a greater length of stay (β: 1.48, 95% CI: 1.15–1.91) and specifically the gap related to procedure/testing (β: 2.01, 95% CI: 1.62–2.47) resulted in a two-fold increase in length of stay. There was no association between 90-day readmission and any of the gaps in care.ConclusionsThere was a strong association between those who had any gap in their care and increased length of stay. Mitigating gaps in care may decrease length of stay and, in turn, result in less risk of infection and could potentially lead to reduced healthcare costs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of gaps in care for malnourished patients on length of stay and hospital readmission

Ringel

Jannat‐Khah

Chambers

et al. 2019

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…A large, multicenter study noted that patients may remain NPO for up to 24 hours, with a majority remaining NPO for >8 hours unintentionally . In a different meta‐analysis, it was shown that about 50% of the meals held for patients could have been served . Such prolonged perioperative/periprocedure fasting has been shown to increase the risk for complications and is often unnecessary …”

Section: Discussionmentioning

confidence: 99%

“…17 In a different metaanalysis, it was shown that about 50% of the meals held for patients could have been served. 18 Such prolonged perioperative/periprocedure fasting has been shown to increase the risk for complications and is often unnecessary. 19,20 In an effort to improve excessive time spent NPO for procedures or testing, we are proposing that physicians be required to document the purpose for NPO status within the patient's order.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Gaps in Care of Malnourished Patients on General Medicine Floors in an Acute Care Setting

Chambers

Bryan²,

Jannat‐Khah³

et al. 2018

Nut in Clin Prac

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“…5 In this study, we aimed to provide action-oriented recommendations by 1) assessing why some interventions did not occur after NPO orders were placed and 2) analyzing NPO orders by indication and comparing them with the best available evidence.…”

mentioning

confidence: 99%

Characteristics and Outcomes of Fasting Orders Among Medical Inpatients

Sorita¹,

Ratelle²,

Bates³

et al. 2017

Journal of Hospital Medicine

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While many hospitalized patients have orders to fast in preparation for interventions, the extent to which these orders are necessary or adhere to evidence-based durations is unknown. In this study, we analyzed the length, indication, and associated outcomes of nil per os (NPO) orders for general medicine patients at an academic institution in the United States, and compared them to the best available evidence for recommended length of NPO. Of 924 NPO orders assessed, the indicated intervention was not performed for 183 (19.8%) orders, largely due to a change in plan (75/183, 41.0%) or scheduling barriers (43/183, 23.5%). When analyzed by indication, the median duration of NPO orders ranged from 8.3 hours for kidney ultrasound to 13.9 hours for upper endoscopy. For some indications, the literature suggested NPO orders may be unnecessary. Furthermore, in indications for which NPO was deemed necessary in the literature, the duration of most NPO orders was much longer than minimally required. These results suggest the need for establishing more robust practice guidelines or institutional protocols for NPO orders. Frequent and prolonged fasting can lead to patient dissatisfaction and distress. 1 It may also cause malnutrition and negatively affect outcomes in high-risk populations such as the elderly. 2 Evidence suggests that patients are commonly kept fasting longer than necessary. 3,4 However, the extent to which nil per os (NPO) orders are necessary or adhere to evidence-based duration is unknown.Our study showed half of patients admitted to the general medicine services experienced a period of fasting, and 1 in 4 NPO orders may be avoidable. 5 In this study, we aimed to provide action-oriented recommendations by 1) assessing why some interventions did not occur after NPO orders were placed and 2) analyzing NPO orders by indication and comparing them with the best available evidence. METHODSThis retrospective study was conducted at an academic medical center in the United States. The study protocol was approved by the Mayo Clinic Institutional Review Board.Detailed data handling and NPO order review processes have been described elsewhere. 5 Briefly, we identified 1200 NPO orders of 120 or more minutes' duration that were written for patients on the general medicine services at our institution in 2013. After blinded duplicate review, we excluded 70 orders written in the intensive care unit or on other services, 24 with unknown indications, 101 primarily indicated for clinical reasons, and 81 that had multiple indications. Consequently, 924 orders indicated for a single intervention (eg, imaging study, procedure, or operation) were included in the main analysis.We assessed if the indicated intervention was performed. If performed, we recorded the time when the intervention was started. If not performed, we assessed reasons why it was not performed. We also performed exploratory analyses to investigate factors associated with performing the indicated intervention. The variables were 1) NPO starting at midnight, 2) ...

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Frequency and Appropriateness of Fasting Orders in the Hospital

Cited by 32 publications

References 43 publications

Impact of gaps in care for malnourished patients on length of stay and hospital readmission

Impact of gaps in care for malnourished patients on length of stay and hospital readmission

Evaluating Gaps in Care of Malnourished Patients on General Medicine Floors in an Acute Care Setting

Characteristics and Outcomes of Fasting Orders Among Medical Inpatients

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