Enhanced recovery after colorectal surgery: principles and current practice

Rao, Pawan Kumar Dhruva; Haray, P. N.

doi:10.1016/j.mpsur.2014.02.014

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…Enhanced recovery after surgery (ERAS) is a multimodal evidence-based approach to patient care that has become the standard in elective colorectal surgery [ 1 , 2 ]. ERAS is an interprofessional, goal-directed programme that begins for patients in the preoperative period and extends through hospital discharge (Table 1 ).…”

Section: Introductionmentioning

confidence: 99%

Successful implementation of an enhanced recovery after surgery programme for elective colorectal surgery: a process evaluation of champions’ experiences

et al. 2015

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BackgroundEnhanced recovery after surgery (ERAS) is a multimodal evidence-based approach to patient care that has become the standard in elective colorectal surgery. Implemented globally, ERAS programmes represent a considerable change in practice for many surgical care providers. Our current understanding of specific implementation and sustainability challenges is limited. In January 2013, we began a 2-year ERAS implementation for elective colorectal surgery in 15 academic hospitals in Ontario. The purpose of this study was to understand the process enablers and barriers that influenced the success of ERAS implementation in these centres with a view towards supporting sustainable change.MethodsA qualitative process evaluation was conducted from June to September 2014. Semi-structured interviews with implementation champions were completed, and an iterative inductive thematic analysis was conducted. Following a data-driven analysis, the Normalization Process Theory (NPT) was used as an analytic framework to understand the impact of various implementation processes. The NPT constructs were used as sensitizing concepts, reviewed against existing data categories for alignment and fit.ResultsFifty-eight participants were included: 15 surgeons, 14 anaesthesiologists, 15 nurses, and 14 project coordinators. A number of process-related implementation enablers were identified: champions’ belief in the value of the programme, the fit and cohesion of champions and their teams locally and provincially, a bottom-up approach to stakeholder engagement targeting organizational relationship-building, receptivity and support of division leaders, and the normalization of ERAS as everyday practice. Technical enablers identified included effective integration with existing clinical systems and using audit and feedback to report to hospital stakeholders. There was an overall optimism that ERAS implementation would be sustained, accompanied by concern about long-term organizational support.ConclusionsSuccessful ERAS implementation is achieved by a complex series of cognitive and social processes which previously have not been well described. Using the Normalization Process Theory as a framework, this analysis demonstrates the importance of champion coherence, external and internal relationship building, and the strategic management of a project’s organization-level visibility as important to ERAS uptake and sustainability.

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Section: Introductionmentioning

confidence: 99%

Successful implementation of an enhanced recovery after surgery programme for elective colorectal surgery: a process evaluation of champions’ experiences

et al. 2015

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“…Both have been shown to improve short-term outcomes in patients undergoing colorectal resections [5,6]. Most current ERPs include incorporation of minimally invasive operative interventions as part of the programme [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…These constitute a paradigm shift in post-operative care moving away from an expectant/reactive model of traditional care to pro-active perioperative interventions [3].…”

Section: Introductionmentioning

confidence: 99%