Work

Use . FAST to Sip Til Send: A Quality Improvement Initiative Using Digital Solutions to Facilitate Best Practice Preoperative Fasting Protocols in Emergency General Surgery

Year: 2026

Type: article

Abstract: BACKGROUND: Reduced preoperative fasting times are beneficial for patients, have negligible aspiration risk and minimise intravenous fluid (IVF) use. For over 15 years the national anaesthetic guidelines in Australia have recommended solid food until 6 h prior to surgery and unlimited clear fluids until 2 h prior to surgery. In 2024 an additional recommendation was added: sips of clear fluids (typically water) up to 200 mL/h until sent to theatres. Nonetheless, 'fast from midnight' (FFM) and 'nil by mouth' (NBM) are commonly used. METHODS: This study was conducted on patients in a single, tertiary, metropolitan hospital. Baseline preoperative fasting data were retrospectively collected from 21/08/2024 to 18/09/2024. A staff education campaign and an EMR smart phrase (".FAST") were then introduced. Post implementation data were prospectively collected from 28/10/2025 to 20/01/2025. Data were analysed for fasting protocol type, total fasting time (TFT), and preoperative IVF use. Data modelling was used to calculate the projected impact of the .FAST protocol. RESULTS: Uptake of best practice fasting guidelines increased from 1% to 47% (p < 0.001). This was associated with a marked IVF use reduction-from 41% to 17% of patients (p < 0.001)-and a decrease in median fasting time from 9 to 2 h (p < 0.001). Median total time on IVF reduced from 8 to 0 h (p < 0.001). Projected annual savings in EGS with 100% uptake of the .FAST protocol were projected to be 23 doctor workdays and 46 nurse workdays (assuming an 8 h workday), and $2460 in IVF cost. CONCLUSIONS: Implementation of a simple to use, contemporary preoperative fasting protocol in EGS through staff education and an EMR smart phrase led to decreased time fasted for patients and IVF use. No patients fasted with .FAST had surgery cancelled due to inadequate fasting.

Source: ANZ Journal of Surgery

DOI: 10.1111/ans.70640

Authors: Denna Fryer, Ché Marfleet, Alexandra Jolley, Kristy Mansour, Benjamin Loveday, Soon Lau