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.
Highlights
The 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
In 2009, the Department of Health in England set up the Enhanced Recovery After Surgery (ERAS) programme and its use has been encouraged in NHS hospitals across the United Kingdom [1]
Interviews lasted between 23 and 78 min and were guided by an interview guide developed from a review of relevant literature with topics for discussion structured around the four main constructs of Normalisation Process Theory [18]
Summary
The 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. In 2009, the Department of Health in England set up the Enhanced Recovery After Surgery (ERAS) programme and its use has been encouraged in NHS hospitals across the United Kingdom [1]. ERAS is an approach to the perioperative care of patients which encompasses multiple evidence-based interventions on the basis that these will improve patient outcomes and speed up their recovery after surgery [2]. To use the ‘efficacy knowledge’ [4] that surrounds ERAS, and translate evidence from trials into routine clinical practice, decision makers require contextual information on effectiveness in different settings, and guidance on implementation [5, 6].
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