Background: Physician shortage and healthcare access is a serious issue in rural America with reports estimating a shortage of more than 45,000 physicians by 2025. The rural and the underserved communities are predominantly served by International Medical Graduates (IMGs). Majority of the IMG physicians work are on a J1 waiver, National Interest Waiver (NIW) program [...]

Background: Traditional inpatient procedural fasting practices lead to excessive periods of patient fasting. Patients are unnecessarily ordered to be nil per os (NPO) at midnight, independent of current recommendations and evidence specific to the type of procedure being performed or expected time for the procedure to occur. This approach is based largely on the assumption [...]

Background: Physician shortage and healthcare access is a serious issue in rural America with reports estimating a shortage of more than 45,000 physicians by 2025. The rural and the underserved communities are predominantly served by International Medical Graduates (IMGs). Majority of the IMG physicians work are on a J1 waiver, National Interest Waiver (NIW) program [...]

Background: Traditional inpatient procedural fasting practices lead to excessive periods of patient fasting. Patients are unnecessarily ordered to be nil per os (NPO) at midnight, independent of current recommendations and evidence specific to the type of procedure being performed or expected time for the procedure to occur. This approach is based largely on the assumption [...]

Background: In the pre-operative setting, hospitalized patients are often made “NPO” after midnight prior to their procedure. This practice stems from concerns about aspiration of stomach contents intra-operatively, though many studies have established that fluid intake preoperatively does not increase aspiration or other adverse outcomes (1-10). Preoperative fasting has, however, been associated with adverse outcomes [...]

Background: Ultrasound-guided thoracentesis and paracentesis are frequently performed for both diagnostic and therapeutic indications. While the risk of aspiration is low, our institution has historically required patients to be fasting for 4 hours prior to the procedure. In the hospital setting, unnecessary fasting requirements could contribute to missed patient meals and procedure delays. Here, we [...]

Background: It has been routine practice to keep patients undergoing cardiac stress testing nil per os (NPO) until the results of the test were reported. The rationale is to enable left heart catheterization the same day if the stress test is positive, thereby reducing time to coronary intervention and length of stay (LOS). Often, NPO [...]

Background: Patients are frequently ordered to fast while hospitalized. Though these “nil per os” (NPO) orders are often placed for sound clinical reasons (e.g. small bowel obstruction), they are also frequently placed in preparation for imaging studies or procedures to reduce the theoretical risk of aspiration. There is often a great deal of confusion among [...]

Background: Hospitalized patients are often kept fasting for various reasons, including clinical conditions, procedures and imaging, or dysphagia (1). Studies have demonstrated the harm of excessive fasting, including increased post-operative delirium (2), thirst and hunger, and patient dissatisfaction. Accordingly, recent guidelines have promoted a more liberal preoperative fasting strategy, namely, allowing clear liquids up to [...]

Background: Utilization of MRI as diagnostic imaging continues to increase in the pediatric population. MRI with sedation accounts for 23% of pediatric MRI studies with 31% of those being inpatient. Barriers to completion of an MRI in pediatric populations includes the frequent use of sedation and poor communication amongst pediatric hospitalist, anesthesia and radiology. With [...]