Failure in Systems and Culture: Barriers That Prevent Implementation of Evidence-Based Fasting Times for Patients in the Acute Care Setting

Abstract

Background: There is strong evidence supporting fasting guidelines of 6 hours' fast from solids and 2 hours' fast from fluids prior to surgery. Despite this, patients spend prolonged periods of time fasting for surgery with a lack of research to support translating this evidence into practice, particularly for emergency surgical theater lists. This study aims to explore barriers and enablers to reduce prolonged fasting for patients on emergency surgical lists in the acute care setting.

Methods: Qualitative interviews were undertaken with 22 health professionals on acute surgical wards within a quaternary referral hospital in Sydney, Australia. Semistructured interviews explored barriers and enablers to implementing evidence-based fasting practices for patients on emergency surgical lists, using a theoretical domains framework. Interviews were transcribed verbatim and analyzed using an inductive thematic approach.

Results: Key barriers to implementing reduced fasting included unpredictable, inflexible systems; cultural concerns; and gaps in knowledge. Major enablers to reducing fasting times are the recognition of patient distress caused by excessive fasting and desire by all 22 interviewees to address the problem.

Conclusions: This research is the first to explore barriers and enablers to implementing interventions to address excessive fasting. This research highlights the complexity of the issue and the need for a multifaceted translational intervention addressing limitations in systems and cultural barriers.

Keywords: fasting; qualitative; surgery.