Development of an Enhanced Recovery After Surgery Guideline and Implementation Strategy Based on the Knowledge-to-action Cycle

McLeod, Robin S.; Aarts, Mary-Anne; Chung, Frances; Eskicioglu, Cagla; Forbes, Shawn S.; Conn, Lesley Gotlib; McCluskey, Stuart A.; McKenzie, Marg; Morningstar, Beverly; Nadler, Ashlie; Okrainec, Allan; Pearsall, Emily; Sawyer, Jason; Siddique, Naveed; Wood, Thomas E.

doi:10.1097/sla.0000000000001067

Cited by 115 publications

(118 citation statements)

References 31 publications

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“…This knowledge can be used to adapt the evidence to develop tailored, context-sensitive interventions; this strategy of using such a knowledge-to-action cycle was recently reported to be successful in implementing ERAS at multiple sites in Canada. 42 Furthermore, this strategy requires consensus among all involved stakeholders. The findings in this study suggest that patients need to be an integral part of developing the ERAS pathway locally, in particular, the preoperative educational component and the criteria for eligibility for the pathway.…”

Section: Discussionmentioning

confidence: 99%

Facilitators and barriers of implementing enhanced recovery in colorectal surgery at a safety net hospital: A provider and patient perspective

Alawadi

Leal

Phatak

et al. 2016

Surgery

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Section: Discussionmentioning

confidence: 99%

Facilitators and barriers of implementing enhanced recovery in colorectal surgery at a safety net hospital: A provider and patient perspective

Alawadi

Leal

Phatak

et al. 2016

Surgery

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“…In other jurisdictions, considerations of implementation of ERAS based on iKT, including an assessment of barriers and enablers, have been reported [25–27]. Mcleod et al used a tailored approach to develop and implement an Enhanced Recovery evidence-based guideline rather than adopting an existing one because of potential limitations inherent in the guideline [25]. This process was undertaken at multiple sites, and an initial assessment of compliance was undertaken.…”

Section: Discussionmentioning

confidence: 99%

“…This process was undertaken at multiple sites, and an initial assessment of compliance was undertaken. In this study, a retrospective chart audit was undertaken to assess compliance with 18 identified ERAS interventions based on the evidence-based guideline that was locally developed [25]. Assessment of compliance was not repeated after implementation.…”

Section: Discussionmentioning

confidence: 99%

Implementation of Enhanced Recovery After Surgery: a strategy to transform surgical care across a health system

et al. 2017

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BackgroundEnhanced Recovery After Surgery (ERAS) programs have been shown to have a positive impact on outcome. The ERAS care system includes an evidence-based guideline, an implementation program, and an interactive audit system to support practice change. The purpose of this study is to describe the use of the Theoretic Domains Framework (TDF) in changing surgical care and application of the Quality Enhancement Research Initiative (QUERI) model to analyze end-to-end implementation of ERAS in colorectal surgery across multiple sites within a single health system. The ultimate intent of this work is to allow for the development of a model for spread, scale, and sustainability of ERAS in Alberta Health Services (AHS).MethodsERAS for colorectal surgery was implemented at two sites and then spread to four additional sites. The ERAS Interactive Audit System (EIAS) was used to assess compliance with the guidelines, length of stay, readmissions, and complications. Data sources informing knowledge translation included surveys, focus groups, interviews, and other qualitative data sources such as minutes and status updates. The QUERI model and TDF were used to thematically analyze 189 documents with 2188 quotes meeting the inclusion criteria. Data sources were analyzed for barriers or enablers, organized into a framework that included individual to organization impact, and areas of focus for guideline implementation.ResultsCompliance with the evidence-based guidelines for ERAS in colorectal surgery at baseline was 40%. Post implementation compliance, consistent with adoption of best practice, improved to 65%. Barriers and enablers were categorized as clinical practice (22%), individual provider (26%), organization (19%), external environment (7%), and patients (25%). In the Alberta context, 26% of barriers and enablers to ERAS implementation occurred at the site and unit levels, with a provider focus 26% of the time, a patient focus 26% of the time, and a system focus 22% of the time.ConclusionsUsing the ERAS care system and applying the QUERI model and TDF allow for identification of strategies that can support diffusion and sustainment of innovation of Enhanced Recovery After Surgery across multiple sites within a health care system.

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“…Finally, only costs linked to the primary hospitalization were calculated (in-hospital costs), the costs for postoperative rehabilitation and recovery time before returning to work were not taken into account in the current analysis. However, despite the lack of actual data on rehabilitation after ERAS, it can be assumed that outpatient recovery may also become easier and faster in ERAS patients [37].…”

Section: Discussionmentioning

confidence: 99%

Cost–Benefit Analysis of the Implementation of an Enhanced Recovery Program in Liver Surgery

et al. 2016

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Development of an Enhanced Recovery After Surgery Guideline and Implementation Strategy Based on the Knowledge-to-action Cycle

Abstract: On the basis of short-term findings, our results suggest that a tailored implementation strategy based on the KTA cycle can be used to successfully implement an ERAS program at multiple sites.

Cited by 115 publications

References 31 publications

Facilitators and barriers of implementing enhanced recovery in colorectal surgery at a safety net hospital: A provider and patient perspective

Facilitators and barriers of implementing enhanced recovery in colorectal surgery at a safety net hospital: A provider and patient perspective

Implementation of Enhanced Recovery After Surgery: a strategy to transform surgical care across a health system

Cost–Benefit Analysis of the Implementation of an Enhanced Recovery Program in Liver Surgery

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