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Adapting an EHR-Based Intervention to Reduce Preprocedural Fasting in Hospitalized Children
Taylor Merritt1, Averi E Wilson1,2, Jami Miller3
1Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas.
Introduction:
Prolonged preprocedural fasting in hospitalized children persists despite American Society of Anesthesiologists (ASA) guidelines permitting clear liquids up to 2 hours before anesthesia. Prior work demonstrated that an electronic health record (EHR) order with ASA-aligned defaults reduces fasting duration; however, evidence regarding replication and sustainability in complex inpatient settings is limited. We evaluated the replication, local adaptation, and clinical impact of a standardized EHR-based nothing-by-mouth order within a quaternary pediatric hospital medicine (PHM) service.
Methods:
We conducted a quasi-experimental interrupted time series (ITS) analysis from January 1, 2023 through April 23, 2025. Eligible encounters included PHM patients aged 0 to 21 years with an active nothing-by-mouth order who underwent anesthesia. The intervention replaced the existing midnight-default order with an ASA guideline-aligned EHR nothing by mouth order. Reach, Effectiveness, Adoption, Implementation, and Maintenance and Practical, Robust Implementation and Sustainability Model frameworks were applied post hoc to contextualize implementation outcomes and characterize contextual determinants, respectively. Segmented regression evaluated changes in monthly mean clear liquid fasting duration.
Results:
Among 1407 encounters (659 preintervention, 748 postintervention), mean clear liquid fasting duration decreased by 30.5%, from 708.6 minutes (11.8 hours) to 492.5 minutes (8.2 hours). ITS demonstrated an immediate reduction in fasting duration of 184 minutes (95% CI, -236.9 to -131.2), with no significant postintervention slope change, indicating sustained improvement over 15 months. Nothing-by-mouth violations and periprocedural emesis did not increase.
Conclusion:
A standardized EHR-based nothing-by-mouth order was associated with a sustained reduction in fasting duration without increases in measured safety outcomes. Structural EHR modification may represent a scalable strategy to improve alignment with guidelines.
