Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2026
Summary
This project implemented a 'Sip - til Send' policy aiming to reduce prolonged clear fluid fasting time (CFFT) at QCH while improving patient satisfaction and maintaining safety utilising an evidence-based quality improvement methods.
Dates: September 2024 - September 2025
Implementation sites: Queensland Children's Hospital
This project was presented as a Poster at CEQ Showcase 2026 (PDF 745KB).
Aim
The objective was to evaluate a 6-4-3-0 fasting policy. Primary outcome was clear fluid fasting time (CFFT) in children. Secondary outcomes were incidence of aspiration/regurgitation events and fasting experience of patients and/or carers at Queensland Children's Hospital (QCH.)
Outcomes
- Primary outcome - median fasting time following intervention
- Median CFFT decreased 42 minutes from 197 minutes (IQR 132-323) in February to 155 minutes (IQR 88-261) in September.
- Other outcomes
- Patients with CFFT within 0-120 minutes increased by 77.9% from February (20.68%) to September (36.79%).
- No increase in adverse events reported.
- Parent/caregiver satisfaction increased following intervention and 66.1% of free-text comments were 'Neutral' or 'Complimentary'.
Background
Adverse effects can arise from prolonged fasting: dehydration, haemodynamic instability, post-operative nausea and vomiting and patient dissatisfaction [1]. At Queensland Children's Hospital (QCH), previous guidelines endorsed a 6-hr fast for solids, 4-hrs for formula and breastmilk and 1-hr for clear fluids[ED1.1]. To introduce and measure effect of “Sip Til Sendâ€, a quality improvement-based implementation was employed. The objective was to evaluate a 6-4-3-0 fasting policy. Primary outcome was clear fluid fasting time (CFFT) in children. Secondary outcomes were incidence of aspiration/regurgitation events and fasting experience of patients and/or carers at QCH.
Methods
Prospective mixed-methods single-centre study at QCH. All patients fasting for elective or emergency surgery were included. Personalised fasting requirements, those not fed orally at baseline, or fasting for non-anaesthetic reasons were excluded. A new guideline was implemented using Consolidated Framework for Implementation Research (CFIR) [2]. Clear fluids could be consumed at 3mL/kg/hr (max 150mL/hr) until called for theatre.
Phase I - Pre-implementation: current fasting practices identified to gather context and targets for implementation efforts.
Phase II - Co-design and implementation: iterative co-design developed targeted interventions to address barriers and facilitators with key stakeholders at individual meetings, semi-structured interviews, open forum multidisciplinary discussions and opportunistic 'drop-in' sessions. Interventions included formal policy change, distribution of one-page document, education of doctors and nurses, announcements at executive-level meetings and visual reminders.
Phase III - Post-implementation: fasting and survey data collected, education, reinforcement of policy and troubleshooting.
Adverse events recorded through existing QCH Morbidity and Mortality mechanisms.
Discussion
From February to September, structured implementation of "Sip 'Til Send" using CFIR at QCH resulted in a sustained 42-minute decrease in median CFFT and 1 in 3 children fasted less than 120 minutes post-intervention compared with 1 in 5 pre-intervention. Parents and caregivers indicated the experience for their child was improved overall and there was no increase in adverse events, consistent with similar studies [1]. Despite this, a significant proportion of patients fasted longer than 6 hours and one third of survey respondents were critical of their experience, emphasising the need for ongoing efforts. This methodology is reproducible in any healthcare setting across Queensland and can be applied to hospitals state-wide.
References
1. Fawcett WJ, Thomas M. Pre-operative fasting in adults and children: clinical practice and guidelines. Anaesthesia. 2019;74(1):83-8.
2. Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implementation Science. 2022;17(1):75.
Key contact
Dr James Brannigan
Principal House Officer
Children's Health Queensland