Case reports, audits and QI publications

Local implementation

Published and publicly reported accounts of sip til send implementation at individual hospitals and health services. Figures are as reported by each source; no site-wide adoption total is tracked here because no public registry exists.

Reported sites

NHS Tayside (Ninewells Hospital), Scotland
2021–

Originating site; term "sip til send" credited to this service

Scope: Adult and paediatric
Source: CPOC resource page; Scottish Health Facilities protocol v1.1
Developed from May 2021 following a departmental poll and audit evidence of a mean 7.5-hour fluid fast; implemented from December 2021. CPOC reports more than 30 UK NHS trusts have since adopted sip til send policies based on this model.
CPOC resource page →
Prince of Wales Hospital, Sydney
2023

First Australian adult hospital reported to adopt sip til send

Scope: Adult, all surgery
Source: Local health district media release
Reported by the local health district and trade media as the first adult hospital in Australia to introduce sip til send, permitting clear fluids until the patient is called for surgery.
SESLHD release →
Royal Adelaide Hospital
2023

Second Australian hospital reported to adopt sip til send

Scope: Adult, all surgery
Source: SA Health media release
SA Health reports the policy allows a standard 200 mL ward cup of clear fluid per hour until the patient is called to theatre. A minimum 6-hour food fast is retained; some patients are excluded for medical or surgical reasons.
SA Health release →
Cairns Hospital, Queensland
2023–

SipTilSend Network ANZ co-founder site; local pilot audit

Scope: Adult and paediatric
Source: ANZCA Bulletin; ANZCA ASM 2025 abstract
Co-founded the Australasian SipTilSend Network (Markman et al., ANZCA Bulletin 2023). A single-site pre/post audit of 14,197 anaesthetics was presented as a conference abstract at the ANZCA Annual Scientific Meeting, Cairns, May 2025, described by the authors as an underpowered proof-of-concept. Cairns also leads the multicentre MARS study — see Key papers.
Sheffield Teaching Hospitals NHS Foundation Trust
2024

Staged quality-improvement rollout across two campuses

Scope: Adult, elective
Source: Anaesthesia Reports 2024;12:e12271
Wiles & Macdonald describe implementation via sequential plan-do-study-act cycles across two hospital campuses, with patient satisfaction as the primary measured outcome. Reports improved satisfaction; no aspiration signal.
Read →
UMC Utrecht, Netherlands
2023 / 2026

Academic centre policy change, with longer-term follow-up

Scope: Adult, elective
Source: JAMA Surg 2023; BJA Open 2026
Marsman et al. first reported a before-and-after cohort following a transition to a liberal fluid policy (JAMA Surg 2023). A 2026 follow-up at the same centre, covering 56,995 patients, reported an aspiration incidence of 3.7 per 10,000 — see Key papers for detail, including why this figure is flagged as a counterpoint worth reading alongside the earlier report.
The Royal Children's Hospital, Melbourne
Ongoing

Published paediatric institutional guideline

Scope: Paediatric
Source: RCH clinical guideline
Publicly documented institutional fasting guideline permitting clear fluids at 3 mL/kg/hour, with a deviation protocol and individual aspiration-risk assessment retained.
RCH guideline →
Klinikum Bremen-Mitte, Germany
2022

Iterative quality-improvement study

Scope: Adult, elective
Source: Anaesthesia 2022;77:1386
Rüggeberg & Nickel describe a multi-cycle QI process moving to unrestricted clear fluid intake, reporting feasibility and no aspiration signal across cycles.
Te Tai Tokerau (Northland), New Zealand
2026

Paediatric QI initiative using an ice block intervention

Scope: Paediatric
Source: Anaesthesia Reports 2026;14:e70056
Wong et al. evaluate a collaboratively designed intervention (an ice block offered pre-operatively) to improve paediatric fluid intake and shorten effective fasting time in the pre-operative area.
Read →

Themes reported across these accounts

Drawn directly from the publications above. Not a systematic synthesis.

Staged rollout. Sheffield and Bremen both used iterative cycles (PDSA or equivalent) rather than a single policy switch.

Defined volumes and fluids. Reported protocols specify a volume limit (for example, 200 mL/hour from a standard ward cup) and a defined list of permitted clear fluids.

Retained exclusions. Every reported protocol retains exclusions for specific patients — by medical condition, surgical procedure, or at individual clinician discretion.

Paediatric-specific adaptation. The Northland QI project targeted fluid intake behaviour directly (via an ice block) rather than relying on policy change alone, reflecting a different implementation barrier in children.

Disclaimer

Case summaries are drawn from published reports and public statements by the institutions named; they are not independently audited by SipTilSend.org. Any institutional change to fasting policy should follow local governance and credentialing processes. This content does not constitute medical or clinical advice; see the full disclaimer.