Resident Duke University Durham, North Carolina, United States
Background: Preoperative fasting has been implemented to reduce pulmonary aspiration risk before anesthesia, despite the risk being rare in children. In clinical practice, preoperative fasting often extends beyond the recommended practice guidelines. Prolonged fasting may have unintended negative consequences on patients with regards to hemodynamic instability, hydration status, and patient satisfaction. In 2018, multiple international societies of pediatric anesthesiology collaboratively developed consensus guidelines liberalizing clear liquids up to one hour prior to procedural sedation. Intentional adherence to liberalized pre-procedural fasting times has been implemented in clinical practice successfully and safely. Interventions aimed towards decreasing pre-procedural fasting times is beneficial for patients. Current evidence favors liberalizing pre-procedural fasting times, however, there remain barriers to optimizing pre-procedural fasting times. Objective: Our primary aim is to increase the percentage of pre-procedural diet orders specifying allowance of clear liquids for pediatric patients up to 1 hour prior to general anesthesia at our quaternary hospital. A secondary aim will be to decrease average NPO duration. Design/Methods: We included pediatric patients (2-18 years of age) who were admitted to the inpatient service at our children’s hospital from September 1, 2022 until October 12, 2023 with pre-procedural diet orders (NPO or clear liquids). The first PDSA cycle included a department wide email with pre-procedural guidelines allowing clear liquids up to one hour prior to general anesthesia. The primary outcome assessed is the number of pre-procedural diet orders that allow clear liquids. The secondary outcome is the duration of NPO start time until anesthesia start time (as documented in the anesthesia note). We are utilizing a process measure of the average number of pediatric anesthesia cases per week. Balancing measures include: case delays or cancellations and aspiration events.
