Quality Improvement Project to Reduce Preoperative Fasting Times Before Elective Procedures

This single-center quality improvement project evaluates preoperative fasting times before elective procedures requiring anesthesiology care. The project aims to reduce prolonged fasting for clear fluids by implementing a local standard operating procedure (SOP) allowing patients to drink clear liquids until being called to the operating room ("drink until called"), supported by staff education and fasting instruction cards. Fasting times and selected perioperative outcomes will be assessed before and after implementation.

Study Overview

• Status: Recruiting
• Conditions: Delirium; Postoperative Pulmonary Complications; Postoperative Nausea and Vomiting (PONV); Preoperative Fasting; Perioperative Patient Comfort / Quality of Care

Detailed Description

Traditionally, surgical patients are instructed to fast for prolonged periods to reduce the risk of pulmonary aspiration. International guidelines recommend fasting from clear liquids for 2 hours prior to elective procedures, yet real-world fasting often extends to 6-10 hours, which can impair patient well-being and may contribute to complications such as dehydration, hypoglycemia, postoperative nausea and vomiting, and delirium-particularly in older or frail patients. This quality improvement project follows the Plan-Do-Study-Act (PDSA) framework.

Plan: Review evidence and decide to implement "drink until called to the OR." Do: Train anesthesiology staff, adapt local SOPs, provide oral patient instructions, and introduce fasting instruction cards for patients and staff.

Study: Record and analyze fasting times and fluid intake prior to anesthesia induction; assess effectiveness and adjust strategies.

Act: Add further staff education, posters, and short instructional screencasts to reinforce the updated fasting guidance.

• Study Type: Observational
• Enrollment (Estimated): 1000

Contacts and Locations

• Study Contact: Name: Marit Habicher, Dr.; Phone Number: +4964198544401; Email: Marit.Habicher@chiru.med.uni-giessen.de
• Study Contact Backup: Name: Brigitte Clausen; Email: Brigitte.Clausen@chiru.med.uni-giessen.de

Study Locations

• Germany
  • Giessen, Germany, 35390
    • Recruiting
    • Justus Liebig University Giessen, University Hospital Giessen and Marburg
    • Contact: Michael Sander, PhD; Phone Number: +4964198544401
    • Contact: Marit Habicher, Dr.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population includes all patients undergoing elective procedures requiring anesthesiology care (general anesthesia, regional anesthesia, sedation, or anesthesiology standby) at University Hospital Giessen during the predefined pre- and post-implementation data collection periods. Patients who are already sedated, intubated, and mechanically ventilated at the time of anesthesia induction are excluded.

Description

Inclusion Criteria:

• All patients elective surgery or intervention requiring with anesthesiology care general anesthesia, regional anesthesia, sedation, or anesthesiology stand-by

Exclusion Criteria:

• Already sedated, intubated, and mechanically ventilated patients

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Control group; before implementation new fasting time program
Intervention group; after implementation a new fasting time program

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Preoperative fasting time (clear liquids and solids)	Time interval between last intake of clear liquids and anesthesia induction. Time interval between last solid meal and anesthesia induction.	At anesthesia induction.
PACU length of stay	PACU length of stay	PACU admission to discharge.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Preoperative fasting time (clear liquids and solids)	Time interval between last intake of clear liquids and anesthesia induction. Time interval between last solid meal and anesthesia induction.	At anesthesia induction (pre vs post implementation periods).
Patient satisfaction regarding fasting	Patient satisfaction regarding fasting (questionnaire)	immediately after the intervention/procedure/surgery up to 1 day postoperatively
Perioperative complications	Perioperative complications (e.g., nausea, vomiting, regurgitation/aspiration)	Intraoperative and immediate postoperative period (PACU).
Postoperative pulmonary and gastrointestinal complications	Pneumonia,Aspiration, nausea and vomiting	During the hospital stay up to 30 days
Delirium occurrence	Occurance of postoperative delir	During the hospital stay, up to 30 days
Hospital length of stay and in-hospital mortality	Hospital length of stay and in-hospital mortality	Until hospital discharge / up to 30 days
Acute kidney injury (AKI)	Acute kidney injury (AKI) (creatinine increase)	Within the first 3 postoperative days.
ICU/IMC admission	ICU/IMC admission (planned/unplanned) and duration	During the hospital stay up to 30 days

Collaborators and Investigators

• Sponsor: University of Giessen

Study record dates

Study Major Dates

• Study Start (Actual): January 30, 2026
• Primary Completion (Estimated): May 30, 2026
• Study Completion (Estimated): July 30, 2026

Study Registration Dates

• First Submitted: February 16, 2026
• First Submitted That Met QC Criteria: March 17, 2026
• First Posted (Actual): March 23, 2026

Study Record Updates

• Last Update Posted (Actual): March 23, 2026
• Last Update Submitted That Met QC Criteria: March 17, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: quality improvement; Preoperative fasting; clear liquids
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Mental Disorders; Postoperative Complications; Pathologic Processes; Signs and Symptoms, Digestive; Confusion; Neurobehavioral Manifestations; Neurocognitive Disorders; Vomiting; Nausea; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Delirium; Postoperative Nausea and Vomiting
• Other Study ID Numbers: AZ 178/25

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No