Implementation of the 'Countdown to Theatre' Approach to Bridge the Evidence-Practice Gap in Paediatric Preoperative Fasting: A Quality Improvement Initiative

Abstract

AIM: To evaluate the 'Countdown to Theatre' intervention, a co-designed nurse-led approach developed using the COM-B framework to address context-specific barriers and facilitators to preoperative fasting practices. DESIGN: A prospective mixed-method, pre-post study assessed the intervention's impact on fasting adherence and patient experience. METHODS: Participants included children booked for a procedure under general anaesthesia. Adherence was assessed through audited fasting duration, and patient experience was evaluated using caregiver/patient surveys. The intervention was implemented and monitored by nursing staff as a part of a structured quality improvement process. Nurses played a central role in embedding the approach into daily workflows and reinforcing fasting timelines RESULTS: Over 9 months, 901 observations were undertaken from 774 patients. Fasting duration decreased from 7.6 to 5.7 h (mean difference -1.94; 95% CI -3.04, -0.86). Parent-reported patient experience surveys showed improvement in many areas, including an increase in overall satisfaction (from 44.7% to 68.8%). CONCLUSION: The intervention successfully reduced prolonged fasting and improved patient experiences, demonstrating the value of co-designed approaches in addressing evidence-practice gaps in perioperative care. IMPLICATIONS FOR PATIENT CARE: The principles of co-design, structured implementation and the application of the COM-B framework provide a replicable model for addressing similar challenges in healthcare. The study highlights the pivotal role of nurses in improving perioperative practices, supporting both patient safety and satisfaction. Future research should explore the intervention's applicability across diverse settings and patient populations. IMPACT: Despite evidence-based guidelines, excessive preoperative fasting remains prevalent in practice. This study demonstrates that a structured, nurse-led intervention can successfully reduce fasting durations and enhance patient experience, reaffirming the nursing profession's capacity to lead meaningful change in perioperative care. REPORTING METHOD: Standards for quality improvement reporting excellence (SQUIRE 2.0). PATIENT OR PUBLIC CONTRIBUTION: Patients and caregivers contributed to the co-design of the intervention, ensuring that it addressed practical challenges related to preoperative fasting.