Using Implementation Science in Surgical Care: A Scoping Review.

Abstract

Improvement of surgical care is dependent upon evidence-based practices (EBPs), policies, procedures, and innovations. The objective of this study was to understand and synthesize the use of implementation science (IS) in surgical care. This article summarizes the existing literature to identify the frequency and types of EBPs selected for surgical care, IS frameworks that guided the published research, and prominent facilitators and barriers. A modified version of the Arksey and O'Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews Checklist were used to provide the guidance and standards to conduct this scoping review. We queried: Ovid MEDLINE; American Psychological Association PsycINFO; Embase; Cumulated Index to Nursing and Allied Health Literature; Web of Science; and Google Scholar for manuscripts published January 2001 - June 2023. The initial search found 3,674 citations of which 129 met inclusion criteria. The heterogeneity and volume of innovations within the surgical IS field were vast. The most frequent innovations were in peri-operative care, safety in surgery, and Enhanced Recovery After Surgery. Six constructs were identified as both major facilitators and barriers: support from leadership; surgeon and staff knowledge regarding EBPs; relationship/team building; environmental context; data; and resources. Identifying these implementation factors used in the surgical field enables us to determine variables that support and inhibit the adoption and implementation of new practices, support practice change, enhance quality and equity of surgical care, and identify research gaps for future IS in surgical care.