543 Analysis of Variation in Pre-Procedural Fasting Duration for Common Inpatient Gastrointestinal Procedures

Abstract

INTRODUCTION: Guidelines from the American Society of Anesthesiologists (ASA) recommend no intake of clear liquids and solid food 2-4 hours and 6-8 hours respectively prior to endoscopic procedures. Because excessively long pre-procedural fasting while inpatient can negatively impact a patient's experience and clinical outcomes, our study analyzed the typical fasting duration for patients undergoing colonoscopy, esophagogastroduodenoscopy (EGD), or endoscopic retrograde cholangiopancreatography (ERCP) at a large tertiary care hospital and determined how these wait times varied across multiple variables. METHODS: Inpatient data for colonoscopy, EGD, and ERCP was extracted as part of a quality improvement evaluation using administrative data and information from the electronic medical record at The Johns Hopkins Hospital between July 2016 and January 2018. The duration of nil per os (NPO) status was calculated from time the NPO order went into effect to the time “Patient in Procedure Room” order was entered. Patients who were NPO greater than 72 hours were excluded as NPO status was more likely secondary to non-procedure factors. Kruskal-Wallis Test/Wilcoxon Test/Pearson Test were used in analysis depending on the outcome type and data distribution. RESULTS: During the study period, there were 753 colonoscopies, 1325 EGDs, and 550 ERCPs performed on inpatients. The median NPO wait time for colonoscopy was 11.9 hours; 12.6 hours for EGD; and 13.1 hours for ERCP (median for all procedures was 12.6 hours; interquartile range 9.6-16.1 hours). Hispanic patients spent more time NPO than non-Hispanic patients (median of 13.9 hours vs. 12.4 hours, P-value = 0.018). There was no statistically significant associations between NPO duration and patient sex, total number of comorbidities, intensive care unit days, length of stay, inpatient unit location, inpatient team, or type of provider placing the orders (physician vs. non-physician). CONCLUSION: The duration of pre-procedural inpatient fasting was between 9.6-16.1 hours for the majority of patients, which consistently exceeds ASA guidelines for pre-procedural fasting. There are many scenarios where longer fasting is clinically indicated particularly for safety; however, these data suggest that for many patients there may be an opportunity to liberalize NPO duration and keep within recommended guidelines. This change may contribute to improved patient experience and minimize potential clinical impact of prolonged fasting.