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Preoperative fasting times and patient experience for elective cesarean delivery – a quality improvement project using the Plan-Do-Study-Act method
Abstract Number: T2A-317
Abstract Type: Original Research
Introduction: The 2016 ASA Practice Guidelines for Obstetric Anesthesia,  and the ERAS Society guidelines for Antenatal and Preoperative care in Cesarean Delivery  suggest that women should be encouraged to drink clear fluids until 2h before and be able to eat a light meal up to 6h before elective surgery. In practice, we have observed that many women are often fasted longer than required, especially when emergency cases impact upon an elective operating list. The aim of this study was to use the Institute for Healthcare Improvement Plan-Do-Study-Act (PDSA) process  to evaluate preoperative fasting times for patients scheduled for cesarean delivery (CD) and to determine patient experience at our institution.
Methods: We conducted a prospective cross-sectional survey on patients scheduled for CD at our institution from September to November 2018. Each parturient was given an 8-item paper survey to complete on arrival to the preoperative unit on the day of surgery. Questions included time of last food and drink, fasting instructions received, experience of thirst, hunger or low energy levels and whether they thought time period for fasting was appropriate. Our primary outcome was the difference between instructed vs actual fasting time for liquids and solids analyzed by paired sample t-tests. Instructed fasting time was defined as the time interval in hours parturients were told to fast up until scheduled time of CD. Actual fasting time was defined as time fasted up until time of entry to the operating room. Secondary outcomes included patient satisfaction and perception on preoperative fasting instructions.
Results: 123 patients of a possible 200 were surveyed during the period; 77 patients refused to participate or were not approached due to language barrier. Full data for 102 patients were analyzed. There was a significant difference in mean instructed and actual fasting duration for liquids (6.6h vs. 8.5h, p<0.00001); and for solids (8.5h vs. 12.5h, p<0.00001). Immediately before surgery 51% of patients reported being thirsty, 52% were hungry, 16% reported low energy levels and 6% reported they were given unclear or conflicting fasting instructions. Approximately 25% of parturients also reported that fasting times for liquids and solids were too long.
Discussion: We found that parturients scheduled for CD at our institution were instructed and fasted for significantly longer than the recommended guidelines and that maternal experience was poor. Based on these findings, we aim to target preoperative staff to improve fasting information given to parturients, so they better align with current guidelines. We also intend to examine factors that delay patient entry to the operating room. A follow-up survey will be conducted to see if these interventions will lead to improved maternal experience.
1. Practice Guidelines for Obstetric Anesthesia. Anesthesiology 2016
2. Wilson RD et al. AJOG 2018
3. Taylor, M et al. BMJ Qual Saf. 2014