Reducing preoperative fasting time for children: A multidisciplinary quality improvement project

Area of Science:

• Pediatric Anesthesiology
• Quality Improvement Science
• Healthcare Informatics

Background:

• Pediatric inpatients undergoing sequential procedures often face prolonged pre-procedure fasting beyond American Society of Anesthesiology (ASA) guidelines.
• Repetitive fasting periods can negatively impact patient well-being and adherence to care protocols.

Purpose of the Study:

• To decrease excessive preoperative fasting durations in pediatric inpatients requiring multiple procedures within a month.
• To implement and evaluate a quality improvement project at a tertiary care facility.

Main Methods:

• A multidisciplinary team identified the "nil per os" (NPO) after midnight Electronic Medical Record (EMR) order as a key factor in prolonged fasting.
• A customizable pre-procedure diet order was implemented, and its impact was monitored using process-control charts over 26 months.
• Plan-do-study-act cycles were employed within the Model for Improvement framework.

Main Results:

• The median percentage of patients fasting for over eight hours decreased from 74% to 50% post-implementation (p=0.005).
• Following the identification of special cause variation at 15 months, prolonged fasting affected only 34% of patients.
• Median NPO duration significantly reduced from 12.6 hours to 7.6 hours (p=0.0001).

Conclusions:

• Implementing a customizable EMR-based pre-procedure diet order effectively reduced preoperative fasting times for pediatric inpatients.
• Successful implementation hinges on multidisciplinary and interprofessional collaboration, adhering to quality improvement best practices.