Barriers to implementation of enhanced recovery after surgery (ERAS) by a multidisciplinary team in China: a multicentre qualitative study

Wang, Dan; Liu, Zhenmi; Zhou, Jing; Yang, Jie; Chen, Xinrong; Chang, Chengting; Liu, Changqing; Li, Ka; Hu, Jian-Kun

doi:10.1136/bmjopen-2021-053687

Cited by 30 publications

(25 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Even when doctors believed that a patient’s physical state met the discharge criteria and that the patient could be discharged, some patients still thought that early discharge was unsafe. 73 Previous studies showed that patients’ different attitudes towards early discharge were related to factors, such as the medical services policy, medical resource allocation, ERAS education, primary healthcare services and family support. 73 If these factors made patients feel worried and dissatisfied, they would have a negative experience with the implementation of the ERAS programme.…”

Section: Discussionmentioning

confidence: 99%

Issues in patients’ experiences of enhanced recovery after surgery (ERAS) : a systematic review of qualitative evidence

Wang

et al. 2023

BMJ Open

Self Cite

View full text Add to dashboard Cite

ObjectiveTo explore patients’ experiences of enhanced recovery after surgery (ERAS) and to identify issues in the implementation of ERAS from the patient’s perspective.DesignThe systematic review and qualitative analysis were based on the Joanna Briggs Institute’s methodology for conducting synthesis.Data sourcesRelevant studies published in four databases, that is, Web of Science, PubMed, Ovid Embase and the Cochrane Library, were systematically searched, and some studies were supplemented by key authors and reference lists.Study selectionThirty-one studies were identified, involving 1069 surgical patients enrolled in the ERAS programme. The inclusion and exclusion criteria were formulated based on the Population, Interest of phenomena, Context, Study design criteria recommended by the Joanna Briggs Institute to determine the scope of article retrieval. The inclusion criteria were as follows: ERAS patients’ experiences; qualitative data; English language and published from January 1990 to August 2021.Data extractionData were extracted from relevant studies using the standardised data extraction tool from Joanna Briggs Institute Qualitative Assessment and Review Instrument for qualitative research.Data synthesisThe themes in the structure dimension are as follows: (1) patients cared about the timeliness of healthcare professionals’ help; (2) patients cared about the professionalism of family care; and (3) patients misunderstood and worried about the safety of ERAS. The themes in the process dimension are as follows: (1) patients needed adequate and accurate information from healthcare professionals; (2) patients needed to communicate adequately with healthcare professionals; (3) patients hoped to develop a personalised treatment plan and (4) patients required ongoing follow-up services. The theme in the outcome dimension is as follows: patients wanted to effectively improve severe postoperative symptoms.ConclusionsEvaluating ERAS from the patient’s perspective can reveal the omissions and deficiencies of healthcare professionals in clinical care so that problems in patients’ recovery process can be solved in a timely manner, reducing potential barriers to the implementation of ERAS.PROSPERO registration numberCRD42021278631.

show abstract

Section: Discussionmentioning

confidence: 99%

Issues in patients’ experiences of enhanced recovery after surgery (ERAS) : a systematic review of qualitative evidence

Wang

et al. 2023

BMJ Open

Self Cite

View full text Add to dashboard Cite

show abstract

“…Moreover, it seems that the clinical practice in small community hospitals compared with large and academic hospitals is significantly associated with a non-use of ERAS protocols [37]. Finally, insufficient financial support for medical and health resources could determine an insufficient reserve of equipment, medicines and material [40].…”

Section: What Type Of Barriers?mentioning

confidence: 99%

Enhanced Recovery after Surgery (ERAS) in Gynecology: State of the Art and the Problem of Barriers

Forte¹,

Ferrari²,

Majd³

et al. 2023

Clin. Exp. Obstet. Gynecol.

View full text Add to dashboard Cite

Objectives:The advantages of the enhanced recovery after surgery (ERAS) protocols application in all surgical branches have been largely demonstrated, even though there is a lack of a strong evidence from randomized trial and the evidence regarding the multimodality treatments is of low grade. Moreover, the problem of the barriers to the implementation of these protocols in clinical practice remains an unsolved problem. Mechanism: We performed a narrative review reporting the main barriers and enablers on the subject. Finding in Brief: The main barriers are resistance to change, lack of support from institutions and of financial resources or manpower, poor communication and collaboration within the multidisciplinary team, organizational problems, lack of standardized protocols, patientrelated barriers (individual factors, reluctance, or inadequate education) and lastly clinical practice in small community hospitals. To overcome these problems, several enablers have been identified including: the involvement of the patient, the reorganization of care systems through standardized ERAS protocols, identification of a leader/coordinator, promotion of teamwork and staff education, financial resources, and the recognition of the role of the professionals involved. Conclusions: At this moment, resistance to change remains the most frequent and difficult barrier to overcome and, in our opinion, a reorganization of the health system aiming to the implementation of the ERAS protocols in the clinical practice is required.

show abstract

“…The concept of ERAS has spread to different surgical specialties and is widely used in patients receiving surgical operations. A multidisciplinary team (MDT), including surgery, anesthesia, pharmacy, nursing, rehabilitation, nutrition, and psychology, with team members made up of doctors, pharmacists, nurses, rehabilitation therapists, and dietitians, is required in the ERAS program, especially in cases of major surgery [ 2 , 3 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Surgical Pharmacy for Optimizing Medication Therapy Management Services within Enhanced Recovery after Surgery (ERAS®) Programs

Xie

Huang

Gao

et al. 2023

JCM

View full text Add to dashboard Cite

Drug-related problems (DRPs) are common among surgical patients, especially older patients with polypharmacy and underlying diseases. DRPs can potentially lead to morbidity, mortality, and increased treatment costs. The enhanced recovery after surgery (ERAS) system has shown great advantages in managing surgical patients. Medication therapy management for surgical patients (established as “surgical pharmacy” by Guangdong Province Pharmaceutical Association (GDPA)) is an important part of the ERAS system. Improper medication therapy management can lead to serious consequences and even death. In order to reduce DRPs further, and promote the rapid recovery of surgical patients, the need for pharmacists in the ERAS program is even more pressing. However, the medication therapy management services of surgical pharmacy and how surgical pharmacists should participate in ERAS programs are still unclear worldwide. Therefore, this article reviews the main perioperative medical management strategies and precautions from several aspects, including antimicrobial agents, antithrombotic agents, pain medication, nutritional therapy, blood glucose monitoring, blood pressure treatment, fluid management, treatment of nausea and vomiting, and management of postoperative delirium. Additionally, the way surgical pharmacists participate in perioperative medication management, and the relevant medication pathways are explored for optimizing medication therapy management services within the ERAS programs. This study will greatly assist surgical pharmacists’ work, contributing to surgeons accepting that pharmacists have an important role in the multidisciplinary team, benefitting medical workers in treating, counseling, and advocating for their patients, and further improving the effectiveness, safety and economy of medication therapy for patients and promoting patient recovery.

show abstract

Barriers to implementation of enhanced recovery after surgery (ERAS) by a multidisciplinary team in China: a multicentre qualitative study

Cited by 30 publications

References 43 publications

Issues in patients’ experiences of enhanced recovery after surgery (ERAS) : a systematic review of qualitative evidence

Issues in patients’ experiences of enhanced recovery after surgery (ERAS) : a systematic review of qualitative evidence

Enhanced Recovery after Surgery (ERAS) in Gynecology: State of the Art and the Problem of Barriers

Surgical Pharmacy for Optimizing Medication Therapy Management Services within Enhanced Recovery after Surgery (ERAS®) Programs

Contact Info

Product

Resources

About