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Effects of a short message service (SMS) by cellular phone to improve compliance with fasting guidelines in patients undergoing elective surgery: a retrospective observational study.

手机短信服务 (SMS) 对提高择期手术患者禁食指南依从性的影响: 一项回顾性观察性研究。

  • 影响因子:2.26
  • DOI:10.1186/s12913-020-06039-y
  • 作者列表:"Zia F","Cosic L","Wong A","Levin A","Lu P","Mitchell C","Shaw M","Rosewarne F","Weinberg L
  • 发表时间:2021-01-06
Abstract

BACKGROUND:Contemporary perioperative fasting guidelines aim to alleviate patient discomfort before surgery and enhance postoperative recovery whilst seeking to reduce the risk of pulmonary aspiration during anesthesia. The impact of a short message service (SMS) reminder on fasting guideline compliance is unknown. Therefore, we performed a retrospective observational study and quality improvement project aiming to quantify the extent of excessive and prolonged fasting, and then assessed the impact of a SMS reminder in reducing fasting times. METHODS:After ethics committee approval we performed a retrospective observational study investigating preoperative fasting times of adult patients undergoing elective surgery. First, we assessed whether the fasting guideline times were adhered to (Standard Care group). All patients received internationally recommended fasting guidelines in the form of a written hospital policy document. We then implemented an additional prompt via a mobile phone SMS 1 day prior to surgery containing a reminder of fasting guideline times (SMS group). The primary aims were to compare fasting times between the Standard Care group and the SMS group. RESULTS:The fasting times of 160 patients in the Standard Care group and 110 patients in the SMS group were evaluated. Adherence to the fasting guidelines for solids occurred in 14 patients (8.8%) in the Standard Care group vs. Twenty-two patients (13.6%) in the SMS group (p=0.01). Adherence to the fasting guidelines for fluids occurred in 4 patients (2.5%) in the Standard Care group vs. Ten patients (6.3%) in the SMS group (p=0.023). Patients in the Standard Care group had a longer median (inter-quartile range (IQR)) fasting time for fluids compared the SMS group [6.5 h (IQR 4.5:11) vs 3.5 h (IQR 3:8.5), p< 0.0001]. Median fasting times for solids were 11 h (IQR 7:14) in the Standard Care group and 11.5 h (IQR 7:13.5) in the SMS group (p=0.756). CONCLUSION:Adherence to internationally recommended fasting guidelines for patients undergoing elective surgery is poor. The introduction of a fasting guideline reminder via a mobile phone SMS in addition to a written hospital policy improved adherence to fasting advice and reduced the fasting times for fluids but not for solids. The use of an SMS reminder of fasting guidelines is a simple, feasible, low-cost, and effective tool in minimising excessive fasting for fluids among elective surgical patients. TRIAL REGISTRATION:ACTRN12619001232123 (Australia New Zealand Clinical Trials Registry). Registered 6th September 2019 (retrospectively registered).

摘要

背景: 当代围手术期禁食指南旨在减轻患者术前不适,增强术后恢复,同时寻求降低麻醉期间肺误吸的风险。短消息服务 (SMS) 提醒对禁食指南合规性的影响尚不清楚。因此,我们进行了一项回顾性观察研究和质量改进项目,旨在量化过度和长时间禁食的程度,然后评估SMS提醒在减少禁食时间方面的影响。 方法: 在伦理委员会批准后,我们进行了一项回顾性观察研究,调查了接受择期手术的成年患者的术前禁食时间。首先,我们评估是否遵守禁食指南时间 (标准治疗组)。所有患者均以书面医院政策文件的形式接受国际推荐的禁食指南。然后,我们在手术前1天通过手机SMS实现了额外的提示,其中包含禁食指南时间的提醒 (SMS组)。主要目的是比较标准护理组和SMS组之间的禁食时间。 结果: 评估了标准护理组160例患者和SMS组110例患者的禁食时间。标准治疗组的14例患者 (8.8%) 和SMS组的22例患者 (13.6%) 坚持了固体禁食指南 (p = 0.01)。标准治疗组中4例患者 (2.5%) 和SMS组中10例患者 (6.3%) 坚持禁食液体指南 (p = 0.023)。与SMS组相比,标准治疗组患者的液体禁食时间中位数 (四分位距 (IQR)) 较长 [6.5 h h (IQR 4.5:11) vs 3.5  h (IQR 3:8.5),p <0.0001]。标准治疗组和SMS组的中位禁食时间分别为11  h (IQR 7:14) 和11.5  h (IQR 7:13.5) (p = 0.756)。 结论: 接受择期手术的患者对国际推荐的禁食指南的依从性较差。除了书面的医院政策之外,通过手机短信引入禁食指南提醒,提高了对禁食建议的依从性,减少了液体禁食时间,但不是固体禁食时间。使用禁食指南的SMS提醒是一种简单、可行、低成本和有效的工具,可以最大限度地减少择期手术患者的过度禁食。 试验注册: ACTRN12619001232123 (澳大利亚新西兰临床试验注册中心)。2019年9月6日注册 (回顾性注册)。

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