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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright (c) 2026 Audrey Shuk Lan Chong, Yu Xiang Wong, Jennette Yeen Yii Chin
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Abstract
Background: Prolonged preoperative fasting among children is a global concern with adverse effects. This quality improvement (QI) project aimed to determine the preoperative fasting duration among children undergoing elective surgery under general anaesthesia (GA) at Sabah Women and Children Hospital and improve adherence to recommended fasting timeframe.
Methods: This was a single-centre, before-after QI project using the Plan-Do-Study-Act cycle, conducted from May to August 2023. A total of 180 children (93 control; 87 intervention) were recruited. A baseline audit was conducted, followed by an intervention using a dual-language written instruction leaflet. The study assessed preoperative fasting duration and evaluated the intervention’s effectiveness.
Results: The intervention group demonstrated shorter median fasting durations. Significant reductions were observed for solid food/formula milk (median difference = -1.9 hours, p < 0.001) and clear fluids (median difference = -3.1 hours, p < 0.001). Adherence significantly improved following intervention: for solid food/formula milk, odds of prolonged fasting were reduced by 70% to 75% (relative risk ratio [RRR] range: 0.25 to 0.30, p ≤ 0.002). Similarly, for clear fluids, odds of fasting ≥ 8 hours were reduced by 81% to 90% (RRR range: 0.10 to 0.19, p ≤ 0.005).
Conclusions: The dual-language written instruction leaflet was associated with improved compliance, reducing prolonged preoperative fasting. However, excessive fasting remains an issue. Further strategies, such as multidisciplinary involvement, text message reminders, and offering drinks two hours before surgery, are warranted to optimise compliance. Future research should involve multi-site studies to validate effectiveness and broader applicability.
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