A qualitative study exploring cardiologists’ decision-making about pre-procedure fasting in interventional cardiology procedures.

Abstract

Background Patients undergoing elective interventional cardiology procedures may be at risk of preventable harm related to lengthy pre-procedural fasting. Variation in practice can directly impact on the provision of safe and high-quality care. Aim This study explored the pre-procedural fasting related decision-making of cardiologists, with the aim of generating evidence to inform the provision of safer patient care. Methods A qualitative study using a descriptive methodology to explore interventional cardiologists’ practice and views about outcomes associated with current fasting practice was conducted in a large metropolitan hospital in Melbourne, Australia. This study was part of a larger program of research exploring the variance in pre-procedural fasting of patients undergoing diagnostic and interventional cardiovascular procedures. Results Eight cardiologists were interviewed. The cohort consisted of those who managed patients pre- and post-procedure, as well as cardiologists who practiced in the Cardiac Catheterisation Laboratory setting. The average fasting time reported by the participants was approximately four to six hours fasting for solid food and clear fluids combined. Two key themes emerged: “Use of standardised protocols versus individualised decision-making” and “Gaps in specific evidence to inform practice in the Cardiac Catheterisation Laboratory”. Conclusion The study confirmed barriers to introducing recommendations for shorter pre-procedural fasting practices in the Cardiac Catheterisation Laboratory. As the cardiologists were managing complex patients, they used precautionary interventions such as intravenous fluids to prevent dehydration, rather than implementing shorter fasting times. More robust evidence based on prospective patient outcome studies is required to support practice change.