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Reducing Fasting Time Before Anesthesia for Pediatric Bronchoscopy: A Quality Improvement Project
Qi Wang1, Lamei Liu1, Shujing Gao1
1Department of Pediatric Respiratory and Immunology Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
Insights
A quality improvement project aimed to shorten pediatric bronchoscopy fasting times but did not achieve overall reduction. Factors like culture and parental cooperation complicated guideline implementation in Southwest China.
Area of Science:
- Pediatric Anesthesiology
- Quality Improvement Science
- Healthcare Management
Background:
- Fasting guidelines before anesthesia are crucial for patient safety.
- Optimizing pre-procedural fasting times in pediatric patients undergoing bronchoscopy is an ongoing challenge.
- Implementing standardized fasting protocols requires understanding local contexts.
Purpose of the Study:
- To reduce fasting time before anesthesia for pediatric bronchoscopy.
- To implement and evaluate a quality improvement project focused on pre-procedural fasting.
- To identify barriers and facilitators to guideline localization in Southwest China.
Main Methods:
- A quality improvement project utilizing the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework.
- Employed Specific, Measurable, Achievable, Relevant, Time-bound (SMART) objectives and the Plan-Do-Check-Act (PDCA) cycle.
- Conducted barrier analysis and used control charts and statistical process control for data analysis.
Main Results:
- The project involved 830 children; the new fasting policy did not significantly reduce overall preoperative fasting time.
- Fasting time for fluid diets (breastfed, formula) decreased (P=.019).
- Fasting duration correlated with surgery volume, patient weight, and general anesthesia use.
Conclusions:
- Reducing pre-procedural fasting times for pediatric bronchoscopy is complex due to cultural, educational, resource, and operational factors.
- Localization of fasting guidelines in Southwest China faced significant implementation challenges.
- Further targeted interventions are needed to address influencing factors and optimize fasting policies for improved patient and family experiences.
Purpose:
To reduce fasting time before anesthesia for pediatric bronchoscopy through a quality improvement project.
Design:
A quality improvement project design was used.
Methods:
This quality improvement project was conducted between May 2022 and April 2023. The project team adopted the Intergrated Promoting Action on Reasearch Implementation in Health Services (i-PARIHS) theoretical framework, combined with Specific, Measurable, Achievable, Relevant, Time-bound (SMART) objectives and the Plan-Do-Check-Act (PDCA) cycle, to implement a series of improvement measures at a large women and children's hospital in Southwest China. Barrier analysis for fasting times and relevant balancing measures were identified. Data were analyzed using control charts and statistical process control methods.
Findings:
A total of 830 children were involved in this project. The results showed that the new fasting policy did not reduce the preoperative fasting time (8.11 ± 1.98 hours vs 8.41 ± 2.11 hours). Subgroup analysis showed that fasting time for fluid diet such as breastfed and formula patients decreased (P = .019, 95%CI: [-0.48, 0.83]). Correlation analysis indicated that fasting time was related to the number of surgeries (r = 0.342, P = .013), patient weight (r = 0.280, P = .044), and general anesthesia (r = 0.732, P < .001).
Conclusions:
Due to cultural differences, education levels, medical resources, operational difficulties, parental cooperation, and policy management issues, this quality improvement project revealed the complexity of reducing preprocedural fasting times for pediatric bronchoscopy, making the localization of fasting guidelines difficult to implement in Southwest China. It emphasized the importance of understanding various factors influencing fasting durations and highlighted the need for further targeted interventions to address these factors effectively. These insights will inform future efforts to optimize fasting policies and improve patient and family experiences.
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