Department of Anesthesia, Ballarat Base Hospital, Ballarat, VIC, 3350, Australia.
Department of Anesthesia, Austin Hospital, 145 Studley Road, Heidelberg, VIC, 3084, Australia.
BMC Health Serv Res. 2021 Jan 6;21(1):27. doi: 10.1186/s12913-020-06039-y.
Contemporary perioperative fasting guidelines aim to alleviate patient discomfort before surgery and enhance postoperative recovery whilst seeking to reduce the risk of pulmonary aspiration during anesthesia. The impact of a short message service (SMS) reminder on fasting guideline compliance is unknown. Therefore, we performed a retrospective observational study and quality improvement project aiming to quantify the extent of excessive and prolonged fasting, and then assessed the impact of a SMS reminder in reducing fasting times.
After ethics committee approval we performed a retrospective observational study investigating preoperative fasting times of adult patients undergoing elective surgery. First, we assessed whether the fasting guideline times were adhered to (Standard Care group). All patients received internationally recommended fasting guidelines in the form of a written hospital policy document. We then implemented an additional prompt via a mobile phone SMS 1 day prior to surgery containing a reminder of fasting guideline times (SMS group). The primary aims were to compare fasting times between the Standard Care group and the SMS group.
The fasting times of 160 patients in the Standard Care group and 110 patients in the SMS group were evaluated. Adherence to the fasting guidelines for solids occurred in 14 patients (8.8%) in the Standard Care group vs. Twenty-two patients (13.6%) in the SMS group (p=0.01). Adherence to the fasting guidelines for fluids occurred in 4 patients (2.5%) in the Standard Care group vs. Ten patients (6.3%) in the SMS group (p=0.023). Patients in the Standard Care group had a longer median (inter-quartile range (IQR)) fasting time for fluids compared the SMS group [6.5 h (IQR 4.5:11) vs 3.5 h (IQR 3:8.5), p< 0.0001]. Median fasting times for solids were 11 h (IQR 7:14) in the Standard Care group and 11.5 h (IQR 7:13.5) in the SMS group (p=0.756).
Adherence to internationally recommended fasting guidelines for patients undergoing elective surgery is poor. The introduction of a fasting guideline reminder via a mobile phone SMS in addition to a written hospital policy improved adherence to fasting advice and reduced the fasting times for fluids but not for solids. The use of an SMS reminder of fasting guidelines is a simple, feasible, low-cost, and effective tool in minimising excessive fasting for fluids among elective surgical patients.
ACTRN12619001232123 (Australia New Zealand Clinical Trials Registry). Registered 6th September 2019 (retrospectively registered).
当代围手术期禁食指南旨在减轻患者手术前的不适，并促进术后恢复，同时降低麻醉期间肺吸入的风险。短信服务（SMS）提醒对禁食指南依从性的影响尚不清楚。因此，我们进行了一项回顾性观察研究和质量改进项目，旨在量化过度和延长禁食的程度，然后评估 SMS 提醒在减少禁食时间方面的作用。
在伦理委员会批准后，我们进行了一项回顾性观察研究，调查了接受择期手术的成年患者的术前禁食时间。首先，我们评估了禁食指南时间是否得到遵守（标准护理组）。所有患者均接受了国际推荐的禁食指南，形式为医院书面政策文件。然后，我们通过手术前一天的移动电话 SMS 发送了一个额外的提示，其中包含禁食指南时间的提醒（SMS 组）。主要目的是比较标准护理组和 SMS 组的禁食时间。
评估了标准护理组的 160 名患者和 SMS 组的 110 名患者的禁食时间。标准护理组中，有 14 名患者（8.8%）遵守了固体禁食指南，而 SMS 组中有 22 名患者（13.6%）遵守了固体禁食指南（p=0.01）。标准护理组中有 4 名患者（2.5%）遵守了液体禁食指南，而 SMS 组中有 10 名患者（6.3%）遵守了液体禁食指南（p=0.023）。与 SMS 组相比，标准护理组的液体禁食中位数（四分位距（IQR））时间更长[6.5 小时（IQR 4.5：11）比 3.5 小时（IQR 3：8.5），p<0.0001]。标准护理组固体禁食的中位数时间为 11 小时（IQR 7：14），SMS 组为 11.5 小时（IQR 7：13.5）（p=0.756）。
接受择期手术的患者对国际推荐的禁食指南的依从性很差。除了医院政策文件外，通过移动电话 SMS 提供禁食指南提醒可提高对禁食建议的依从性，并减少液体禁食时间，但不能减少固体禁食时间。使用 SMS 提醒禁食指南是一种简单、可行、低成本且有效的工具，可最大限度地减少择期手术患者液体的过度禁食。
ACTRN12619001232123（澳大利亚新西兰临床试验注册中心）。2019 年 9 月 6 日注册（追溯注册）。
