Title : Thirst for change: Improving pre-operative hydration for emergency surgery in a district general hospital
Abstract:
Historically, patients undergoing emergency surgery are routinely instructed to fast from food for six hours and clear fluids for two hours before arriving to theatre [1]. However, in practice, patients often remain fasted for much longer periods of time, causing unnecessary unpleasant symptoms and patient dissatisfaction [2]. The ‘Sip ‘til Send’ initiative, pioneered by NHS Tayside, permits patients to sip small volumes of clear fluid until they are sent to theatre. This quality improvement project aimed to implement the ‘Sip ‘til Send’ policy at Lincoln County Hospital, a district general hospital in Lincolnshire.
Methods: Following stakeholder engagement and process mapping, we aimed to improve awareness and implementation of the ‘Sip ‘til Send’ policy, thereby enhancing pre-operative hydration and patient experience. Root-cause analysis highlighted key barriers to knowledge and implementation of the policy. Baseline data was collected over four weeks using patient surveys. Interventions included staff education (via email, posters and face-to-face sessions) targeting medical, nursing and catering teams. Post-intervention data was collected using the same survey methodology.
Results: Patient awareness of the ‘Sip ‘til Send’ policy increased from 18% to 90%. Average fasting time for clear fluids reduced from approximately eight hours to one hours and 20 minutes. Hydration variability between patients decreased significantly. Encouragingly, references to ‘Sip ‘til Send’ began appearing in surgical clerking notes, reflecting signs of a positive cultural change.
