NPO at Midnight: Reassessing Unnecessary Pre-Endoscopy Fasting

Endoscopy with sedation is a common inpatient procedure. "NPO after midnight" remains the prevailing fasting practice despite ASA guidelines indicating specific fasting times. This quality improvement project aims to assess patient discomfort with the "NPO after midnight" order versus implementation of specific NPO times.

Patients in the inpatient wards scheduled for endoscopy after 1 pm the following day were recruited. The gastroenterology services designated specific NPO times per ASA guidelines for the post-intervention group. Each participant completed a survey qualifying hunger, thirst, and discomfort levels. Pearson's chi-squared analysis was performed.

NPO duration was reduced in the post-intervention group with significant improvement in thirst, hunger, and discomfort levels. A shortened preoperative fasting period did not lead to increase in procedural complications.

Despite ASA guidelines, the practice of keeping patients NPO after midnight remains pervasive, resulting in unnecessarily prolonged fasting and patient discomfort. Implementing specific diet recommendations reduces duration of NPO and improves patient comfort and overall satisfaction.