Implementing enhanced recovery pathways: a literature review with realist synthesis

Abstract

identified, including original research, reviews, case studies and guideline documents. Full texts were analysed, cross-examined, and data extracted and synthesised.Results: Several implementation strategies were identified, including the contexts in which these operated, the subsequent mechanisms of action that were triggered, and the outcome patterns they produced. Context-Mechanism-Outcome (CMO) configurations were generated, tested, and refined.These were grouped to develop two programme theories concerning ERP implementation, one related to the strategy of consulting with staff, the other with appointing a change agent to coordinate and drive the implementation process. These theories highlight instances in which implementation could be improved. Conclusion:Current literature in ERP research is primarily focussed on measuring patient outcomes and cost effectiveness, and as a result, important detail regarding the implementation process is often not reported or described robustly. This review not only provides recommendations for future improvements in ERP implementation, but also highlights specific areas of focus for furthering ERP implementation research.

Prospective application of an implementation framework to improve postoperative nutrition care processes: Evaluation of a mixed methods implementation study

“…Implementation of some individual care practices is easier than others, and adherence is typically lowest for postoperative elements occurring in the complex ward environment . This may reflect greater challenges in changing practice across the multiple disciplines involved …”

“…Such approaches have been shown to be effective for implementing practice change initiatives across health systems, and implementation frameworks provide a tool for planning and evaluating implementation strategies that may help to ensure that ineffective implementation is not at fault when practice change initiatives fail to demonstrate improvements inpatient outcomes . However, few ERAS studies report prospective use of appropriate theory to plan implementation strategies …”

“…14 This may reflect greater challenges in changing practice across the multiple disciplines involved. 15 Implementation science has emerged as a scientific approach to translating knowledge into practice, with the goal of improving health services. 16 Such approaches have been shown to be effective for implementing practice change initiatives across health systems, 14 and implementation frameworks provide a tool for planning and evaluating implementation strategies that may help to ensure that ineffective implementation is not at fault when practice change initiatives fail to demonstrate improvements inpatient outcomes.…”

“…17 However, few ERAS studies report prospective use of appropriate theory to plan implementation strategies. 15 Increasing number of older patients are undergoing surgery, 18 and they are vulnerable to deleterious effects of hospitalisation such as malnutrition, functional decline and reduced quality of life. [19][20][21] Local audit identified poor adherence to the nutrition-related aspects of the ERAS guidelines in older patients on general surgical wards, including prolonged preoperative fasting and delays in postoperative diet upgrade (i.e.…”

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

“…Ineffective implementation may be one reason for the observed poor adherence to perioperative care protocols (Michie et al, 2005;Moore & Evans, 2017). Studies infrequently provide sufficient detail to assess the implementation strategy (Coxon, Nielsen, Cross, & Fox, 2017), nor is the implementation process reported in sufficient detail to be repeatable by readers (Stone, Yuan, Rosen, & et al, 2018). This, in addition to many studies failing to report the process as per established reporting guidelines, were identified as major gaps in the literature by authors of a 2018 systematic review that synthesised quantitative and qualitative studies reporting barriers and enablers to implementation of perioperative care pathways (Stone et al, 2018).…”