Healthcare professionals’ views of the enhanced recovery after surgery programme: a qualitative investigation

Abstract

BackgroundThe Enhanced Recovery After Surgery (ERAS) programme is an approach to the perioperative care of patients which aims to improve outcomes and speed up recovery after surgery. Although the evidence base appears strong for this programme, the implementation of ERAS has been slow. This study aimed to gain an understanding of the facilitating factors and challenges of implementing the programme with a view to providing additional contextual information to aid implementation. The study had a particular focus on the nutritional elements as these have been highlighted as important.MethodsThe study employed qualitative research methods, guided by the Normalisation Process Theory (NPT) to explore the experiences and opinions of 26 healthcare professionals from a range of disciplines implementing the programme.ResultsThis study identified facilitating factors to the implementation of ERAS: alignment with evidence based practice, standardising practice, drawing on the evidence base of other specialties, leadership, teamwork, ERAS meetings, patient involvement and education, a pre-operative assessment unit, staff education, resources attached to obtaining The Commissioning for Quality and Innovation (CQUIN) money, the ward layout, data collection and feedback, and adapting the care pathway.A number of implementation challenges were also identified: resistance to change, standardisation affecting personalised patient care, the buy-in of relevant stakeholders, keeping ERAS visible, information provision to patients, resources, palatability of nutritional drinks, aligning different ward cultures, patients going to non-ERAS departments, spreading the programme within the hospital, differences in health issue, and utilising a segmental approach. ConclusionsThe findings presented here provide useful contextual information from diverse surgical specialties to inform healthcare providers when implementing ERAS in practice. Addressing the challenges and utilising the facilitating factors identified in this study, could speed up the rate at which ERAS is adopted, implemented and embedded.

Évaluation d’impact d’une nouvelle organisation en chirurgie orthopédique sur les parcours de soins

“…La résistance au changement peut venir également des patients et de leurs proches qui ont besoin d'être rassurés sur le fait que la réduction de la durée de séjour ne constitue pas un risque pour la qualité des soins. La littérature (Wick et al, 2015 ;Pearsall et al, 2015 ;Herbert et al, 2017 ;Fournier et al, à Malgré tous ces freins, on observe un nombre non négligeable d'établissements qui ont investi dans cette démarche. Nous pouvons donc nous interroger sur les motivations des établissements à pratiquer la Raac.…”

Investigating the nutritional status and care of older (≥65 years) general surgical patients: a multiphase, action research study

“…As previously identified, implementation science in the perioperative care setting is in its infancy Gramlich et al, 2017;Herbert et al, 2017;Lyon et al, 2014;. Barriers relevant to the intervention itself also exist, such as failure to adapt the guideline to the local context, degree of fit to an often diverse patient group and adoption of a segmental approach or 'over tailoring' of the intervention (Gramlich et al, 2017;Herbert et al, 2017;Lyon et al, 2014;Sutton et al, 2018), as well as a reported tension between standardised versus individualised care (Lyon et al, 2014). Cohesive, visible leadership and adequate ongoing multidisciplinary staff education are identified as enablers at the micro-level.…”

“…At the meso-level (i.e. local and organisational context), lack of formal leadership support, unsupportive culture, limited stakeholder buy-in, complex systems and processes, and failure to establish ongoing audit and feedback processes were identified as barriers to implementation (Gotlib Conn et al, 2015;Gramlich et al, 2017;Herbert et al, 2017;Pearsall et al, 2015;Sutton et al, 2018), whereas embedding the change into existing systems and processes was an enabler (Herbert et al, 2017).…”

“…Barriers unique to sustainability of ERAS programs were identified as cessation of implementation-specific funding (e.g. where this has funded additional resources) and keeping the intervention locally contained, or in other words, failure to spread (Ament et al, 2017;Herbert et al, 2017).…”

“…Despite the ERAS literature recommending early return to solid diet (within 24 hours), reported study protocols indicate varied interpretation of 'early nutrition' (Rattray, Roberts, Marshall, & Desbrow, 2017). Achieving clinical consensus around aspects of these protocols that are not underpinned by empirical evidence is challenging (Herbert et al, 2017) and facilitates the perpetuation of outdated surgical care practices.…”