Reducing Fasting Time Before Anesthesia for Pediatric Bronchoscopy: A Quality Improvement Project.

Abstract

Purpose: To reduce fasting time before anesthesia for pediatric bronchoscopy through a quality improvement project.

Design: A quality improvement project design was used.

Methods: This quality improvement project was conducted between May 2022 and April 2023. The project team adopted the Intergrated Promoting Action on Reasearch Implementation in Health Services (i-PARIHS) theoretical framework, combined with Specific, Measurable, Achievable, Relevant, Time-bound (SMART) objectives and the Plan-Do-Check-Act (PDCA) cycle, to implement a series of improvement measures at a large women and children's hospital in Southwest China. Barrier analysis for fasting times and relevant balancing measures were identified. Data were analyzed using control charts and statistical process control methods.

Findings: A total of 830 children were involved in this project. The results showed that the new fasting policy did not reduce the preoperative fasting time (8.11 ± 1.98 hours vs 8.41 ± 2.11 hours). Subgroup analysis showed that fasting time for fluid diet such as breastfed and formula patients decreased (P = .019, 95%CI: [-0.48, 0.83]). Correlation analysis indicated that fasting time was related to the number of surgeries (r = 0.342, P = .013), patient weight (r = 0.280, P = .044), and general anesthesia (r = 0.732, P < .001).

Conclusions: Due to cultural differences, education levels, medical resources, operational difficulties, parental cooperation, and policy management issues, this quality improvement project revealed the complexity of reducing preprocedural fasting times for pediatric bronchoscopy, making the localization of fasting guidelines difficult to implement in Southwest China. It emphasized the importance of understanding various factors influencing fasting durations and highlighted the need for further targeted interventions to address these factors effectively. These insights will inform future efforts to optimize fasting policies and improve patient and family experiences.