This single-center quality improvement project evaluates preoperative fasting times before elective procedures requiring anesthesiology care. The project aims to reduce prolonged fasting for clear fluids by implementing a local standard operating procedure (SOP) allowing patients to drink clear liquids until being called to the operating room ("drink until called"), supported by staff education and fasting instruction cards. Fasting times and selected perioperative outcomes will be assessed before and after implementation.

Traditionally, surgical patients are instructed to fast for prolonged periods to reduce the risk of pulmonary aspiration. International guidelines recommend fasting from clear liquids for 2 hours prior to elective procedures, yet real-world fasting often extends to 6-10 hours, which can impair patient well-being and may contribute to complications such as dehydration, hypoglycemia, postoperative nausea and vomiting, and delirium-particularly in older or frail patients. This quality improvement project follows the Plan-Do-Study-Act (PDSA) framework.

Plan: Review evidence and decide to implement "drink until called to the OR." Do: Train anesthesiology staff, adapt local SOPs, provide oral patient instructions, and introduce fasting instruction cards for patients and staff.

Study: Record and analyze fasting times and fluid intake prior to anesthesia induction; assess effectiveness and adjust strategies.

Act: Add further staff education, posters, and short instructional screencasts to reinforce the updated fasting guidance.

Inclusion Criteria:

• All patients elective surgery or intervention requiring with anesthesiology care general anesthesia, regional anesthesia, sedation, or anesthesiology stand-by

Exclusion Criteria:

• Already sedated, intubated, and mechanically ventilated patients

The study population includes all patients undergoing elective procedures requiring anesthesiology care (general anesthesia, regional anesthesia, sedation, or anesthesiology standby) at University Hospital Giessen during the predefined pre- and post-implementation data collection periods. Patients who are already sedated, intubated, and mechanically ventilated at the time of anesthesia induction are excluded.