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Decreasing pre-procedural fasting times in hospitalized children
Alison R Carroll1, Allison B McCoy2, Katharina Modes3
1Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Insights
Reducing fasting times for pediatric patients undergoing procedures significantly decreased pre-procedural fasting from over 10 hours to about 6 hours, improving patient care.
Area of Science:
- Pediatric Hospital Medicine
- Quality Improvement Science
- Patient Safety
Background:
- Prolonged pre-procedural fasting in children is linked to reduced patient satisfaction and increased hemodynamic instability.
- Current guidelines recommend a 2-hour clear liquid fasting period.
Purpose of the Study:
- To decrease the average pre-procedural clear liquid fasting time for pediatric hospital medicine patients from 10 hours 13 minutes to 5 hours.
- To improve patient and family satisfaction and reduce hemodynamic instability associated with fasting.
Main Methods:
- A quality improvement initiative was implemented at a quaternary care children's hospital.
- Interventions included modifying the NPO (nil per os) order using SmartPhrases and hospital-wide changes to order formats.
- Statistical process control charts analyzed average fasting times, NPO order documentation, aspiration events, and case delays.
Main Results:
- Implementation of a SmartPhrase led to a significant reduction in average fasting time from 10 hours 13 minutes to 6 hours 37 minutes.
- A subsequent hospital-wide NPO order format change further reduced fasting time to 6 hours 7 minutes, sustained for 6 months.
- No aspiration events occurred, and NPO violations were minimal (4) during the intervention period.
Conclusions:
- Quality improvement methodologies and higher reliability interventions can effectively and safely reduce pre-procedural fasting times in hospitalized children.
- These interventions enhance patient safety and experience by shortening necessary fasting periods.
Objective:
Prolonged pre-procedural fasting in children is associated with decreased patient and family satisfaction and increased patient hemodynamic instability. Practice guidelines recommend clear liquid fasting times of 2 h. We aimed to decrease pre-procedural clear liquid fasting time from 10 h 13 min to 5 h for pediatric hospital medicine (PHM) patients.
Methods:
All children admitted to the PHM service at a quaternary care children's hospital with an NPO (nil per os) order associated with a procedure requiring general anesthesia or sedation from November 2, 2017 to September 19, 2021 were included. The primary outcome measure was the average time from clear liquid fasting end time to anesthesia start time. The process measure was the percent of NPO orders including a documented clear liquid fasting end time. Balancing measures were aspiration events and case delays/cancellations. Statistical process control charts were used to analyze outcomes.
Results:
Shortly after implementation of a SmartPhrase in the NPO order, there was special cause variation resulting in a centerline shift from a mean of 10 h 13 min to 6 h 37 min and an increase in the process measure from a baseline of 2%-52%. Following implementation of a hospital-wide change to the NPO order format, another centerline shift to 6 h 7 min occurred which has been sustained for 6 months. No aspiration events and four NPO violations occurred during the intervention period.
Conclusion:
Quality improvement methodology and higher reliability interventions safely decreased the average pre-procedural fasting time in hospitalized children.
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