Quality Improvement Project to Reduce Preoperative Fasting Times Before Elective Procedures

Delirium, Perioperative Patient Comfort / Quality of Care, Postoperative Nausea and Vomiting (PONV), Postoperative Pulmonary Complications, Preoperative Fasting

Preoperative fasting, clear liquids, quality improvement

This single-center quality improvement project evaluates preoperative fasting times before elective procedures requiring anesthesiology care. The project aims to reduce prolonged fasting for clear fluids by implementing a local standard operating procedure (SOP) allowing patients to drink clear liquids until being called to the operating room ("drink until called"), supported by staff education and fasting instruction cards. Fasting times and selected perioperative outcomes will be assessed before and after implementation.

Traditionally, surgical patients are instructed to fast for prolonged periods to reduce the risk of pulmonary aspiration. International guidelines recommend fasting from clear liquids for 2 hours prior to elective procedures, yet real-world fasting often extends to 6-10 hours, which can impair patient well-being and may contribute to complications such as dehydration, hypoglycemia, postoperative nausea and vomiting, and delirium-particularly in older or frail patients. This quality improvement project follows the Plan-Do-Study-Act (PDSA) framework. Plan: Review evidence and decide to implement "drink until called to the OR." Do: Train anesthesiology staff, adapt local SOPs, provide oral patient instructions, and introduce fasting instruction cards for patients and staff. Study: Record and analyze fasting times and fluid intake prior to anesthesia induction; assess effectiveness and adjust strategies. Act: Add further staff education, posters, and short instructional screencasts to reinforce the updated fasting guidance.

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Germany