Is there Supporting Evidence for Routine Nil per Os Status in the Emergency Department? A Scoping Review

The routine practice of keeping emergency department patients nil per os is widespread, often stemming from traditional inpatient protocols rather than emergency department--specific evidence. Although guidelines exist for nil per os before procedural sedation and analgesia, their universal application in the dynamic emergency department environment can lead to prolonged fasting, patient discomfort, and potential adverse outcomes, directly impacting nursing care and patient satisfaction. This scoping review aimed to summarize existing data on the efficacy and impact of nil per os status in emergency department patients and to evaluate the evidence supporting the traditional, routine nil per os practice during emergency department stays.

A systematic scoping review was conducted using Medline, Embase, Web of Science, and CINAHL databases (inception to June 2025). Original studies assessing emergency department nil per os status on patient outcomes, including aspiration risk, vomiting, delays in emergent or urgent surgical procedures, and patient or provider satisfaction, were included.

Out of 2274 screened studies, 21 met the inclusion criteria. The majority (n = 13, 62%) evaluated fasting status and adverse outcomes following procedural sedation and analgesia in the emergency department. All 13 studies consistently found no significant association between patient fasting status and adverse events in adult and pediatric patients undergoing emergency department procedural sedation and analgesia. Furthermore, 6 studies analyzing nil per os duration for procedural sedation and analgesia also reported no statistically significant association with adverse events. Four studies revealed that most patients undergoing procedural sedation and analgesia in the emergency department did not adhere to established American Academy of Pediatrics/American Society of Anesthesiology fasting guidelines.

Despite its prevalence, this review identifies limited emergency department-specific evidence to support routine nil per os status, particularly beyond procedural sedation and analgesia. Most included studies focused on pediatric procedural sedation and analgesia populations, and the findings should therefore be interpreted cautiously when applied to adult and older adult populations. Among patients undergoing emergency department procedural sedation and analgesia, no association was found between preprocedural fasting and adverse events. Existing fasting guidelines are largely extrapolated from elective surgical populations rather than the emergency department setting. These findings support the re-evaluation of routine nil per os practices and reinforce the role of emergency nurses in advocating for individualized, evidence-based patient care.