Clinician perspectives on implementing reduced preoperative fasting in Australia

Background Preoperative overnight fasting of patients (no oral intake from midnight until the time of surgery) is a potentially harmful practice; nevertheless, it remains common. Prolonged preoperative fasting is frequent, at times up to 24 hours of fluid and nutrition deprivation. International guidelines recommend reduced fasting time to improve patient outcomes, but this evidence is not well implemented. This study investigated clinician perspectives on two interventions designed to reduce preoperative fasting.

The qualitative study was informed by the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews were conducted virtually or in person, with a purposive sample of perioperative health professionals. Thematic analysis revealed codes, some of which were specific to the two reduced fasting interventions (SipTilSend and oral carbohydrate loading), organised according to the CFIR constructs.

and Conclusions Twenty-one multidisciplinary clinicians were interviewed. Within the CFIR domains, adaptability enabled the tailoring of interventions to clinical contexts, while governance and policy updates supported adoption (Innovation). Progressive anaesthesia team leaders and leadership engagement drove change (Individuals). However, outdated policies and disincentives hindered progress (Outer Setting). Barriers included a lack of knowledge, while knowledge dissemination and clinician commitment to patient safety facilitated uptake (Inner setting). Champions among anaesthesia leaders and perioperative interdisciplinary collaboration played key roles in implementation success (Process). University of Newcastle Human Research and Ethics Committee Approval No: H-2021-0328 Competing Interest Statement The authors have declared no competing interest. Funding Statement Oya Gumuskaya was supported by the Australian College of Perioperative Nurses 2021 Research Grant, the Australian College of Perianaesthesia Nurses 2023 Research Grant. Oya Gumuskaya and Sarah Aitken were supported by the Sydney Health Partners Implementation Science Pilot Grant for this research. Mitchell Sarkies is supported by an NHMRC Investigator Grant (CIA Sarkies 2007970) and Sydney Horizon Fellowship. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was granted from the University of Newcastle Human Research Ethics Committee (Approval no. H-2021-0328). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability The data are stored at the University of Sydney Research Data Management System and can be made available upon request.