• Erin Hommel, Fatoumatta B Sissoho, Karen Chang, and Krishna Suthar.
• Department of Medicine, Division of Geriatrics and Palliative Care, The University of Texas Medical Branch, Galveston, Texas, USA.
• J Hosp Med. 2023 May 1; 18 (5): 375381375-381.

BackgroundPre-procedural fasting (nil per os [NPO]) is a commonly implemented protocol to prevent aspiration during certain diagnostic and therapeutic procedures. However, evidence suggests aspiration risk is quite low. Current guidelines support a reduced fasting duration before procedures necessitating anesthesia or sedation, but many health systems persist in the use of NPO past midnight.ObjectiveWe aimed to reduce the use of NPO p MN before inpatient diagnostic and therapeutic procedures necessitating anesthesia or sedation by 50% within 6 months.Design, Setting And ParticipantsWe performed a quality improvement initiative at a single academic health system in Southeast Texas. We include the experience of patients of all ages across 4 affiliated hospitals (one main academic hospital and three community satellite hospitals).InterventionAn interprofessional team was convened to review best practices and oversee this quality improvement initiative. Diagnostic imaging protocols previously requiring NPO were amended to reflect evidence-based fasting requirements. A pre-procedure clear liquid diet was also implemented.Main Outcome And MeasuresWe describe the steps to implementation, feasibility of implementation as described through key process measures, and the safety of implementation (balancing measures).ResultsNPO requirements were removed from 70% of existing diagnostic imaging and therapeutic orders. After these amended protocols and the implementation of a pre-procedure clear liquid diet, we displayed an immediate 50% reduction in NPO past midnight usage. Further stakeholder engagement/education and targeted interventions reduced NPO past midnight usage to only 33% of pre-procedural diet orders. Surgery remains the most common indication for continued use of NPO. Aspiration events and procedural delays were rare.© 2023 Society of Hospital Medicine.

17 keywords...

hide…