Quality-improvement project to reduce actual fasting times for fluids and solids before induction of anaesthesia

Witt, Lars; Lehmann, B.; Sümpelmann, Robert; Dennhardt, Nils; Beck, Christiane

doi:10.1186/s12871-021-01468-6

Cited by 12 publications

(10 citation statements)

References 22 publications

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“…There have been several approaches to reduce fasting times. Education and training reduced the mean time of liquid fasting in adults from 11 h to 5 h in one study [7].…”

Section: Introductionmentioning

confidence: 95%

“…There have been several approaches to reduce fasting times. Education and training reduced the mean time of liquid fasting in adults from 11 h to 5 h in one study [7]. Removal of the traditional ‘nil by mouth from midnight’ instructions, patient education, a clear fasting routine with pre‐operative drinks and improved communication between the full multidisciplinary team led to a similar reduction in fasting times from 16.3 h to 5.1 h in adults [8].…”

Section: Introductionmentioning

confidence: 99%

“…to take medication), the median (IQR [range]) fasting time was 12.0 (9.5-14.0 [0.8-23.5]) h.Act: Unfortunately, giving permission for unrestricted drinking until called to the operating theatre did not result in short liquid fasting times. Evaluation of further concepts led to the decision to introduce additional educational interventions, which some study groups have used to achieve shorter liquid fasting times[7,8]. As we accepted shorter fasting times than those specified in guidelines with our unrestricted drinking until called to the operating theatre approach, we decided to use fasting cards.…”

mentioning

confidence: 99%

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Unrestricted drinking before surgery: an iterative quality improvement study

Rüggeberg

Nickel

2022

Anaesthesia

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Average pre-operative fasting times for clear liquids are many times longer than those specified in national and international guidelines. We sought to decrease fasting times by applying a quality management tool aimed at continuous improvement. Through the application of iterative `plan-do-study-act´cycles, tools to reduce preoperative liquid fasting times were developed and applied, the effects measured, analysed and interpreted and the conclusions used to inform the next plan-do-study-act cycle. The first step was the introduction of unrestricted drinking until the patient was called to the operating theatre, with training of anaesthetic staff, adaption of local standard procedures and verbal information for patients. This did not result in short liquid fasting times, median (IQR [range]) 12.0 (9.5-14.0 [0.8-23.5]) h. In the second cycle, fasting cards were introduced as a subliminal written training tool for staff, patients and their relatives. This enabled short liquid fasting times to be achieved for outpatients (2.6 (0.8-5.1 [0.3-16]) h) and pre-admission patients (3.4 (1.8-9.4 [0.2-17.2]) h), but not for inpatients (6.5 (2.0-11.7 [0.2-16.2]) h). The third cycle included lectures for ward staff, putting up information posters throughout the hospital, revision of all written materials and provision of screencasts on the homepage for staff and patients. This decreased median liquid fasting time to 2.1 (1.2-3.8 [0.4-18.8]; p < 0.0001) h, with inpatients having the shortest fasting time of 1.4 (1.1-3.8 [0.4-18.8]) h. Repeated quality improvement cycles, adapted to local context, can support sustained reductions in pre-operative liquid fasting times.

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“…There have been several approaches to reduce fasting times. Education and training reduced the mean time of liquid fasting in adults from 11 h to 5 h in one study [7].…”

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Unrestricted drinking before surgery: an iterative quality improvement study

Rüggeberg

Nickel

2022

Anaesthesia

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“…A potential downside, which may have contributed to our negative results, is that, in practice, many patients might not avail themselves of the opportunity to drink unlimited uids up to 2 hours before surgery due to a variety of factors. Other authors have pointed to examples of large differences in actual fasting times compared to provided fasting instructions, which are potentially explained by poor instructions, unintentional patient non-compliance or other unde ned variables 17 . While there was a signi cant difference in reported fasting times in our study, i.e.…”

Section: Discussionmentioning

confidence: 99%

Randomized Controlled Trial of Liberal vs. Standard Fasting Instructions in Percutaneous Cardiac Procedures

Atkinson

Romeiser

Almasry

et al. 2023

Preprint

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Background Pre-procedural fasting to reduce aspiration risk is usual care prior to surgery requiring anesthesia. Prolonged fasting, however, can result in dehydration and may adversely affect patient experience and outcomes. Previous studies suggest that providing a supplemental beverage to patients undergoing cardiac and a variety of other surgical procedures improves patients’ subjective assessment of thirst and hunger and potentially decreases the need for inotrope and vasopressor therapy. Less is known, however, about the effects of ad libitum clear liquids up to 2 hours prior to surgery. Methods Adult patients undergoing transcatheter aortic valve replacement (TAVR) or arrhythmia ablation were randomized (1:1) to ad libitum clear liquids up to 2 hours prior to their procedure vs. nil per os (NPO) after midnight (control group, usual care). The primary endpoint was a composite satisfaction score that included patient-reported thirst, hunger, headache, nausea, lightheadedness, and anxiousness prior to surgery. The incidence of case-delay was recorded. Intraoperative vasopressor administration, changes in creatinine, anti-emetic use, and hospital length of stay (LOS) were recorded. Safety endpoints including aspiration were assessed. Results A total of 200 patients were randomized and 181 patients were included in the final analysis. Overall, 92% of patients were ASA class III or IV and 23% of patients had NYHA class III or IV symptoms. Groups were well balanced with no significant differences in age, sex or baseline cardiac or renal disease. The composite satisfaction score (primary endpoint) was not significantly different between groups (Ad libitum median = 12, IQR = [6, 17], vs Standard NPO median = 10, IQR = [5, 15], [95% CI = [-1, 4]). No significant differences between the two groups were observed in any of the individual survey questions (thirst, hunger, headache, nausea, lightheadedness, anxiousness). No significant differences between groups were observed for intra-operative vasopressor use, changes in creatinine, rescue anti-emetic use or hospital LOS. There were no case delays attributed to the intervention. There were no cases of suspected aspiration. Conclusion No adverse events or case delays were observed in the ad libitum clears group. No significant benefit, however, was observed in patient satisfaction or any of the pre-specified secondary endpoints in patients randomized to ad libitum clear liquids up to 2 hours prior to their procedure.

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“…Quality improvement measures to implement the 2 h liquid fasting have not yet resulted in liquid withdrawal times in the range recommended by guidelines. 129 , 130 , 131 , 132 , 133 In a survey of Indian anaesthetists, only 20% reported following the ASA guideline. 134 In an international survey, only about half of the anaesthetists recommended that patients continue to drink clear liquids up to 2 h before surgery.…”

Section: Prolonged Liquid Fastingmentioning

confidence: 99%

Preoperative fasting and the risk of pulmonary aspiration—a narrative review of historical concepts, physiological effects, and new perspectives

Rüggeberg,

Meybohm,

Nickel

2024

BJA Open

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Quality-improvement project to reduce actual fasting times for fluids and solids before induction of anaesthesia

Cited by 12 publications

References 22 publications

Unrestricted drinking before surgery: an iterative quality improvement study

Unrestricted drinking before surgery: an iterative quality improvement study

Randomized Controlled Trial of Liberal vs. Standard Fasting Instructions in Percutaneous Cardiac Procedures

Preoperative fasting and the risk of pulmonary aspiration—a narrative review of historical concepts, physiological effects, and new perspectives

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