Using quality improvement methods to reduce clear fluid fasting times in children on a preoperative ward
Richard J G Newton1, Grant M Stuart1, Daniel J Willdridge2
1Department of Anaesthesia, Great Ormond Street Hospital, London, UK.
Insights
Quality improvement methods significantly reduced prolonged fasting in children, decreasing mean fluid fasting time to 3.1 hours and increasing the percentage of children drinking within 4 hours to 72%.
Area of Science:
- Pediatric Anesthesiology
- Quality Improvement Science
- Healthcare Management
Background:
- Prolonged fasting in children can lead to increased irritability and adverse hemodynamic effects during anesthesia induction.
- Optimizing preoperative fasting protocols enhances patient comfort and physiological stability.
- Improved preoperative fasting experiences benefit both pediatric patients and their caregivers.
Purpose of the Study:
- To identify causes of prolonged fasting in pediatric patients.
- To implement quality improvement (QI) strategies to reduce fasting duration.
- To achieve a target of 75% of children fasting for clear fluids for less than 4 hours.
Main Methods:
- A quality improvement (QI) project was conducted from January 2014 to August 2016 at a tertiary pediatric hospital.
- Key interventions included clarifying procedure start times, providing accurate parental information, empowering staff, and allowing late oral fluid intake.
- Plan-Do-Study-Act cycles and tools like driver diagrams and failure mode and effects analysis were utilized.
Main Results:
- Pre-project, only 19% of children fasted for fluids <4 hours (mean 6.3 hours).
- Post-project, 72% of patients received fluids within 4 hours, with a reduced mean fluid fasting time of 3.1 hours.
- Secondary outcomes, including aspiration rates and cancellations, did not increase.
Conclusions:
- Established QI methodology effectively reduced mean fluid fasting time in pediatric day admissions.
- The proportion of children fasting for less than 4 hours significantly increased from 19% to 72%.
- QI initiatives can optimize preoperative fasting protocols for pediatric patients.
Objectives:
We applied quality improvement (QI) methodology to identify the different aspects of why children fasted for prolonged periods in our institution. Our aim was for 75% of all children to be fasted for clear fluid for less than 4 hours.
Background:
Prolonged fasting in children can increase thirst and irritability and have adverse effects on haemodynamic stability on induction. By reducing this, children may be less irritable, more comfortable and more physiologically stable, improving the preoperative experience for both children and carers.
Methods:
We conducted a QI project from January 2014 until August 2016 at a large tertiary pediatric teaching hospital. Baseline data and the magnitude of the problem were obtained from pilot studies. This allowed us to build a key driver diagram, a process map and conduct a failure mode and effects analysis. Using a framework of Plan-Do-Study-Act cycles our key interventions primarily focused on reducing confusion over procedure start times, giving parents accurate information, empowering staff and reducing variation by allowing children to drink on arrival (up to one hour) before surgery.
Results:
Prior to this project, using the 6,4,2 fasting rule for solids, breast milk, and clear fluids, respectively, 19% of children were fasted for fluid for less than 4 hours, mean fluid fasting time was 6.3 hours (SD 4.48). At the conclusion 72% of patients received a drink within 4 hours, mean fluid fasting reduced to 3.1 hours (SD 2.33). The secondary measures of aspiration (4.14:10 000) and cancellations have not increased since starting this project.
Conclusions:
By using established QI methodology we reduced the mean fluid fasting time for day admissions at our hospital to 3.1 hours and increased the proportion of children fasting for less than 4 hours from 19% to 72%.
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