A protocol is not enough to implement an enhanced recovery programme for colorectal resection

Maessen, J.; Dejong, Cornelis H. C.; Hausel, Jonatan; Nygren, Jonas; Lassen, Kristoffer; Andersen, Jens T.; Kessels, Alphons G.H.; Revhaug, Arthur; Kehlet, Henrik; Ljungqvist, Olle; Fearon, K.C.H.; Meyenfeldt, M.F. von

doi:10.1002/bjs.5468

Cited by 481 publications

(378 citation statements)

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“…Although the implementation process was not the primary focus for the original articles, it is important to emphasise that the aims of an intervention can only be achieved if it is implemented appropriately [5]. If implementation strategies are not prioritised and considered carefully, this can limit the effectiveness and sustainability of the intervention, and this is reflected in the wider international ERP literature [36 38].…”

Section: Discussionmentioning

confidence: 99%

“…Although the evidence supporting the use of ERPs as a means of optimising surgical outcomes is continually growing, guidelines and research into the ERP implementation process is limited [5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Despite careful consideration given to the design of ERPs, accounts of successful implementation are inconsistent, with post-operative elements of ERPs (such as mobilisation and rehabilitation) often suffering low rates of adherence from staff [5,10]. Hospital wards are busy and complex environments, and integrating ERPs with existing practice can be challenging.…”

Section: Introductionmentioning

confidence: 99%

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Implementing enhanced recovery pathways: a literature review with realist synthesis

et al. 2017

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Implementing enhanced recovery pathways: a literature review with realist synthesis

et al. 2017

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“…Audit: compliance and outcome A key issue to ensure the success of an ERP is compliance with all the elements. 11 Gustafsson's group using a large database showed that with increasing compliance with the number of ERAS elements there was a proportional reduction in length of stay and complications. 12 It is therefore important to have regular audit and compliance even in centers with established ERPs.…”

Section: Introductionmentioning

confidence: 99%

Pathophysiology of Major Surgery and the Role of Enhanced Recovery Pathways and the Anesthesiologist to Improve Outcomes

Scott

Miller

2015

Anesthesiology Clinics

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KEYWORDSEnhanced recovery pathway Fast-track surgery Anesthesia Perioperative care Pathophysiology of surgery Stress response to surgery Metabolic response to surgery Minimally invasive surgery KEY POINTSEnhanced recovery pathways aim to reduce the stress response and improve the metabolic response to surgery restoring the patient to preoperative function more quickly.It is increasingly recognized that rapid, uncomplicated, recovery reduces not only the cost and length of stay of the patient episode but medical and possibly surgical related complications. Provided defined discharge criteria are met readmission rates are not increased.Minimally invasive surgery is a key component of enhanced recovery to reduce the primary injury of tissue damage and blood loss, which both drive the stress response and metabolic response to surgery.All elements of an enhanced recovery pathway are important because they interact positively with each other, a term likened to the sum of small gains.The anesthesiologist plays a key role in optimizing surgical outcomes by controlling a patient's physiology throughout the perioperative pathway.Anesthesiology Clin 33 (2015) 79-91 http://dx

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“…An international observational study, including Dutch centres, evaluated the implementation of an enhanced recovery programme in five European centres and examined the determinants affecting recovery and LOS (Maessen et al, 2007). This study showed that the median LOS was 8 days for standard treatment.…”

Section: Losmentioning

confidence: 99%

Analysis of the health economic impact of medical nutrition in the Netherlands

Freijer

Nuijten

2010

Eur J Clin Nutr

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Objective: A health economic analysis was performed to assess the cost-effectiveness of oral nutritional supplements (ONS), being a medical nutrition product, in the Netherlands. Methods: This analysis is based on a comparison of the use of ONS versus 'no use' of ONS in patients undergoing abdominal surgery. The costs and benefits of the two treatment strategies were assessed using a linear decision analytical model reflecting treatment patterns and outcomes in abdominal surgery. The incremental cost difference was based on costs associated with ONS and hospitalization. Clinical probabilities and resource utilization were based on clinical trials and published literature; cost data were derived from official price tariffs. Results: The use of ONS reduces the costs with a h 252 (7.6%) cost saving per patient. The hospitalization costs reduce from h 3,318 to h 3,044 per patient, which is a 8.3% cost saving and corresponds with 0.72 days reduction in length of stay. The use of ONS would lead to an annual cost saving of a minimum of h 40.4 million per year. Sensitivity analyses showed that the use of ONS remains cost saving compared with 'no use' of ONS. A threshold analysis on the length of stay shows that at 0.64 days, the use of ONS is still cost-effective, which is an unrealistic value. Conclusions: This analysis shows that the use of medical nutrition, ONS in this case, is a cost-effective treatment in the Netherlands and is dominant over standard care without medical nutrition: it leads to cost savings and a higher effectiveness.

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A protocol is not enough to implement an enhanced recovery programme for colorectal resection

Abstract: Functional recovery in 3 days after colorectal resection could be achieved in daily practice. A protocol is not enough to enable discharge of patients on the day of functional recovery; more experience and better organization of care may be required.

Cited by 481 publications

References 32 publications

Implementing enhanced recovery pathways: a literature review with realist synthesis

Implementing enhanced recovery pathways: a literature review with realist synthesis

Pathophysiology of Major Surgery and the Role of Enhanced Recovery Pathways and the Anesthesiologist to Improve Outcomes

Analysis of the health economic impact of medical nutrition in the Netherlands

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