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Hydrate While You Wait: Sunnybrook keeping patients hydrated before surgery

Apr 15, 2019

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Sunnybrook is the first hospital in Canada to trial a new oral hydration initiative, allowing patients awaiting surgery the chance to consume clear fluids closer to their operation.

“This new initiative will improve the overall experience of many patients having surgery at Sunnybrook. Bringing it to reality has been a true team effort,” says Dr. Avery Nathens, Sunnybrook’s surgeon-in-chief.

Traditionally, patients are restricted from eating and drinking after midnight on the day of their scheduled surgery, but medical evidence no longer supports this practice. In fact, it appears patients feel better and recover more quickly if they stay hydrated.

With the new Hydrate While You Wait initiative, eligible patients are able to drink clear fluids throughout the day, up until two hours before time of anticipated surgery.

“Literature shows that adequate nutrition and hydration can improve postoperative outcomes for patients undergoing surgery, so finding an efficient way to keep patients hydrated was a natural step,” says Jordan Filion, a clinical dietitian at Sunnybrook who spearheaded the project as part of a research fellowship.

So far, the first month of the trial has shown promising results: patients are now spending a median of only 38% of their pre-operative time fasting from food and fluids, down from 79% last year.

How the current process works

Until now, because there hasn’t been a consistent system for tracking exactly how long a patient will be waiting for surgery, patients would not be allowed to eat or drink by mouth (also known as NPO) after midnight the day of their scheduled surgery.

If a patient’s surgery doesn’t end up going ahead that day (which is common in a busy trauma centre like Sunnybrook), they are typically told they can eat and drink for a few hours that evening, only to start the fasting process over again at midnight.

"In some cases, patients are on call for multiple days, and their number one complaint is not being able to drink water and not being able to eat for much of that time,” says Gerry Hubble, a registered nurse and patient care manager at Sunnybrook.

How the new process works

The new process starts in the operating room, where the coordinating team huddles several times throughout the day to review the potential ordering of surgical cases.

“We’ve been able to maximize the effectiveness of TrackOR, a technology we’re already using in our operating rooms, to do something that’s nurse-driven and patient-centred,” says Hubble.

With this new process, Hubble says the decision-making power has been transferred to the nurses.

“The nurses are the ones who are at the bedside delivering patient care, and now they’re able to manage the hydration of the patients themselves.”

If a patient is anticipated to be more than two hours away from surgery, a green water glass icon will appear next to their name in TrackOR, meaning they can be given clear fluids to drink up until the cut-off time decided by the coordinating team.

If the patient is anticipated to go to the operating room within the next two hours, a red water glass icon will appear next to their name, meaning that they cannot receive clear fluid hydration.

While participation in Hydrate While You Wait is limited to eligible patients admitted to two units for now, there are plans to expand the initiative across the hospital.

Dr. Claude Laflamme, staff anaesthesiologist at Sunnybrook, says this project shows that compassion for patients can lead to change.

“The Hydrate While You Wait initiative is a perfect example where clinicians, administrators and leaders knew there was an opportunity for improvement and joined forces to find a creative solution to improve the patient experience.”

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Media contact
Sybil Millar
sybil.millar@sunnybrook.ca
416-480-4040