Enhancing Compliance With Preoperative Fasting Guidelines: A Closed-Loop Quality Improvement Initiative to Optimize Patient Safety and Outcomes

Introduction Preoperative fasting is essential in surgical care to reduce the risk of pulmonary aspiration during anesthesia. International guidelines, such as those from the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology (ESA), recommend fasting durations of six hours for solids and two hours for clear liquids. However, adherence to these guidelines often varies in clinical practice, leading to prolonged fasting times that can negatively impact patient outcomes, including dehydration, hypoglycemia, discomfort, and delayed recovery. This quality improvement study aimed to evaluate adherence to international preoperative fasting guidelines within cardiovascular and thoracic surgery wards, identify barriers to compliance and implement targeted interventions to enhance adherence and improve patient outcomes. Methods The study was conducted using the Plan-Do-Study-Act cycle methodology. The study included 769 patients scheduled for elective procedures. A baseline audit of 90 (out of the 769) patients in September 2023 revealed that 86 (95.6%) and 82 (91.1%) fasted, respectively, from clear fluids for more than two hours and solid food for more than six to 12 hours, indicating significant non-adherence to the guidelines. This was followed by the implementation of an intervention plan that included staff training, patient education, and the introduction of a preoperative fasting checklist. Quarterly audits were conducted to assess the effectiveness of these interventions. Data on fasting durations, patient demographics, and associated complications were collected and analyzed using descriptive statistics and regression analysis. Results Following the intervention, there was a marked improvement in adherence, with significant reductions in prolonged fasting times across each quarter (p < 0.001). The last audit showed 529 (68.8%) fasted for more than two hours and 530 (68.9%) patients fasted for more than six to 12 hours, respectively, from clear fluids and solid food. Median fasting times were 4.1 hours for clear fluids and 12.0 hours for solid food. These improvements were accompanied by a reduction in postoperative complications such as dehydration, hypoglycemia, and postoperative nausea and vomiting. The study identified key barriers to adherence, including inadequate staff understanding of guidelines, inconsistent patient instructions, and changes in operating room schedules. The interventions effectively addressed these issues, though patients scheduled for afternoon surgeries continued to experience longer fasting durations than those scheduled for morning surgeries, suggesting the need for further adjustments to preoperative protocols. Conclusion This quality improvement study demonstrated that adherence to international preoperative fasting guidelines can be significantly enhanced through targeted interventions. The successful reduction in fasting durations and associated complications underscores the importance of continuous monitoring and protocol adjustments to align fasting practices with the best evidence, ultimately optimizing patient safety, comfort, and surgical outcomes.