The Quality Improvement Challenge-How Nurses and Allied Health Professionals Can Solve the Knowing-Doing Gap in Enhanced Recovery after Surgery (ERAS).

Thomas W Wainwright

doi:10.3390/medicina56120652

Abstract

The English National Health Service (NHS), and all health services around the world, will continue to face economic and capacity challenges. Quality improvement (QI) interventions, such as Enhanced Recovery after Surgery (ERAS), that are proven to improve patient care and deliver operational benefits are therefore needed. However, widespread implementation remains a challenge. Implementation of ERAS within the NHS over the last 10 years is reviewed, with a focus on total hip arthroplasty (THA) and total knee arthroplasty (TKA). Difficulties with implementation are highlighted, and a recommendation for the future is presented. This perspective is novel in the ERAS literature, and centres around increasing the understanding of perioperative care teams on the need for utilising a recognised QI method (e.g., plan–do–study–act cycles, Lean, and Six Sigma) to implement ERAS protocols (which are a QI intervention) successfully. The importance of differentiating between a QI method and a QI intervention has value across all other ERAS surgical procedures.

Highlights

Health services around the world, including the English National Health Service (NHS), have faced economic and capacity challenges over the last 10 years, and these will remain and increase following the global COVID-19 pandemic
Quality improvement (QI) approaches may be used to improve the quality of patient care and save money, but their success is both dependent on the local context and how they are implemented [1,2]
Implementing an Enhanced Recovery after Surgery (ERAS) protocol involves the introduction of a QI intervention into a dynamic environment, across multiple departments, with a varied network of multidisciplinary relationships, and it normally challenges existing working traditions

Summary

Introduction

Health services around the world, including the English National Health Service (NHS), have faced economic and capacity challenges over the last 10 years, and these will remain and increase following the global COVID-19 pandemic. The ongoing reduction in resources and increasing demand for services, will provide an immense challenge to NHS organisations and staff. Quality improvement (QI) approaches may be used to improve the quality of patient care and save money, but their success is both dependent on the local context and how they are implemented [1,2]. Surgery (ERAS) (or enhanced recovery/fast-track) protocols are a QI intervention and are a multi-modal approach to care which has been shown to reduce mortality, morbidity, and length of stay (LOS) across a range of elective surgical procedures [3]

The History of ERAS Implementation within the NHS

Why Has ERAS Not been More Widely Adopted within the NHS?

Recommendations for the Future Implementation of ERAS

Conclusions