Skip to main content
Erschienen in: World Journal of Surgery 6/2014

01.06.2014

A Qualitative Study Assessing the Barriers to Implementation of Enhanced Recovery After Surgery

verfasst von: Alison Lyon, Michael J. Solomon, James D. Harrison

Erschienen in: World Journal of Surgery | Ausgabe 6/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

Previous studies have quantitatively assessed Enhanced Recovery After Surgery (ERAS) guideline implementation and compliance, and identified the existence of compliance issues with the programs. This is the first study to qualitatively assess the reasons behind compliance issues in ERAS programs. The aim of this study was to elicit barriers to implementation and functioning of the ERAS program at Royal Prince Alfred Hospital.

Methods

A series of interviews were carried out with key stakeholders in order to explore barriers preventing effective functioning of the program 1 year after implementation. Interview transcripts were analysed. Data analysis involved a grounded theory methodology.

Results

Analysis of the data identified four key themed areas of practice that presented barriers: patient-related factors, staff-related factors, practice-related issues, and resources. These overarching themes were generated from subcategories that were linked to generate theory.

Conclusions

For the ERAS program to be implemented successfully with high levels of element compliance, the four key areas need to be addressed. As barriers to ongoing effective care become apparent, these should be managed in order to optimize the synergistic effects of this multimodal program of patient care.
Literatur
1.
Zurück zum Zitat Donohoe CL, Nguyen M, Cook J, Geagan Murray S, Chen N, Zaki F, Mehigan BJ, McCormick PH, Reynolds JV (2011) Fast-track protocols in colorectal surgery. Surgeon 9(2):95–103PubMedCrossRef Donohoe CL, Nguyen M, Cook J, Geagan Murray S, Chen N, Zaki F, Mehigan BJ, McCormick PH, Reynolds JV (2011) Fast-track protocols in colorectal surgery. Surgeon 9(2):95–103PubMedCrossRef
2.
Zurück zum Zitat Gustafsson UO, Scott MJ, Schwenk W et al (2013) Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg 37(2):259–284. doi:10.1007/s00268-012-1772-0 PubMedCrossRef Gustafsson UO, Scott MJ, Schwenk W et al (2013) Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg 37(2):259–284. doi:10.​1007/​s00268-012-1772-0 PubMedCrossRef
3.
Zurück zum Zitat Polle SW, Wind J, Fuhring JW, Hofland J, Gouma DJ, Bemelman WA (2007) Implementation of a fast-track perioperative care program: what are the difficulties? Dig Surg 24:441–449PubMedCrossRef Polle SW, Wind J, Fuhring JW, Hofland J, Gouma DJ, Bemelman WA (2007) Implementation of a fast-track perioperative care program: what are the difficulties? Dig Surg 24:441–449PubMedCrossRef
4.
Zurück zum Zitat Maessen J, Dejong CHC, Hausel J et al (2007) A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg 94:224–231PubMedCrossRef Maessen J, Dejong CHC, Hausel J et al (2007) A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg 94:224–231PubMedCrossRef
5.
Zurück zum Zitat Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J, Enhanced Recovery After Surgery Working Group (2011) Adherence to the Enhanced Recovery After Surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 146(5):571–577PubMedCrossRef Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J, Enhanced Recovery After Surgery Working Group (2011) Adherence to the Enhanced Recovery After Surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 146(5):571–577PubMedCrossRef
7.
Zurück zum Zitat Varadhan KK, Neal KR, Dejong CHC et al (2010) The Enhanced Recovery After Surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 29(4):434–440PubMedCrossRef Varadhan KK, Neal KR, Dejong CHC et al (2010) The Enhanced Recovery After Surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 29(4):434–440PubMedCrossRef
8.
Zurück zum Zitat Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248(2):189–198PubMedCrossRef Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248(2):189–198PubMedCrossRef
9.
Zurück zum Zitat Bickman L, Rog DJ (2005) The SAGE handbook of applied social research methods, vol 2. Sage Publications, Thousand Oaks, p 236 Bickman L, Rog DJ (2005) The SAGE handbook of applied social research methods, vol 2. Sage Publications, Thousand Oaks, p 236
10.
Zurück zum Zitat Woods P (2006) A standard approach to organisation in successful writing for qualitative researchers, vol 2. Routledge, New York, pp 32–35 Woods P (2006) A standard approach to organisation in successful writing for qualitative researchers, vol 2. Routledge, New York, pp 32–35
13.
Zurück zum Zitat Kehlet H, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183(6):630–641PubMedCrossRef Kehlet H, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183(6):630–641PubMedCrossRef
14.
Zurück zum Zitat Fearon KCH, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K et al (2005) Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24:466–477PubMedCrossRef Fearon KCH, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K et al (2005) Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24:466–477PubMedCrossRef
15.
Zurück zum Zitat Vlug MS, Wind J, Hollmann MW et al (2011) Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomised clinical trial (LAFA-study). Ann Surg 254(6):868–875PubMedCrossRef Vlug MS, Wind J, Hollmann MW et al (2011) Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomised clinical trial (LAFA-study). Ann Surg 254(6):868–875PubMedCrossRef
16.
Zurück zum Zitat Vlug MS, Wind J, Van der Zaag E, Ubbink DT, Cense HA, Bemelman WA (2009) Systematic review of laparoscopic vs open colonic surgery within an enhanced recovery programme. Colorectal Dis 11:335–343PubMedCrossRef Vlug MS, Wind J, Van der Zaag E, Ubbink DT, Cense HA, Bemelman WA (2009) Systematic review of laparoscopic vs open colonic surgery within an enhanced recovery programme. Colorectal Dis 11:335–343PubMedCrossRef
17.
Zurück zum Zitat Raymond TM, Kumar S, Dastur JK, Adamek JP, Khot UP, Stewart MS, Parker MC (2010) Case controlled study of the hospital stay and return to full activity following laparoscopic and open colorectal surgery before and after the introduction of an enhanced recovery programme. Colorectal Dis 12:1001–1006PubMedCrossRef Raymond TM, Kumar S, Dastur JK, Adamek JP, Khot UP, Stewart MS, Parker MC (2010) Case controlled study of the hospital stay and return to full activity following laparoscopic and open colorectal surgery before and after the introduction of an enhanced recovery programme. Colorectal Dis 12:1001–1006PubMedCrossRef
18.
Zurück zum Zitat Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Eng J Med 350(20):2050–2059CrossRef Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Eng J Med 350(20):2050–2059CrossRef
19.
Zurück zum Zitat Marusch F, Koch A, Schmidt U et al (2005) The impact of the risk factor “age” on the early postoperative results of surgery for colorectal carcinoma and its significance for perioperative management. World J Surg 29(8):1013–1021. doi:10.1007/s00268-005-7711-6 PubMedCrossRef Marusch F, Koch A, Schmidt U et al (2005) The impact of the risk factor “age” on the early postoperative results of surgery for colorectal carcinoma and its significance for perioperative management. World J Surg 29(8):1013–1021. doi:10.​1007/​s00268-005-7711-6 PubMedCrossRef
20.
Zurück zum Zitat Stewart BT, Stitz RW, Lumley LW (1999) Laparoscopically assisted colorectal surgery in the elderly. Br J Surg 86(7):938–941PubMedCrossRef Stewart BT, Stitz RW, Lumley LW (1999) Laparoscopically assisted colorectal surgery in the elderly. Br J Surg 86(7):938–941PubMedCrossRef
21.
Zurück zum Zitat Scharfenberg M, Raue W, Junghans T, Schwenk W (2007) “Fast-track” rehabilitation after colonic surgery in elderly patients: is it feasible? Int J Colorectal Dis 22:1469–1474PubMedCrossRef Scharfenberg M, Raue W, Junghans T, Schwenk W (2007) “Fast-track” rehabilitation after colonic surgery in elderly patients: is it feasible? Int J Colorectal Dis 22:1469–1474PubMedCrossRef
22.
Zurück zum Zitat Bardram L, Funch-Jensen P, Kehlet H (2000) Rapid rehabilitation in elderly patient after laparoscopic colonic resection. Br J Surg 87:1540–1545PubMedCrossRef Bardram L, Funch-Jensen P, Kehlet H (2000) Rapid rehabilitation in elderly patient after laparoscopic colonic resection. Br J Surg 87:1540–1545PubMedCrossRef
23.
Zurück zum Zitat Brown D, McCormick B (2006) Determining factors that have an impact upon effective evidence-based pain management with older people, following colorectal surgery: an ethnographic study. J Clin Nurs 15:1287–1298PubMedCrossRef Brown D, McCormick B (2006) Determining factors that have an impact upon effective evidence-based pain management with older people, following colorectal surgery: an ethnographic study. J Clin Nurs 15:1287–1298PubMedCrossRef
24.
Zurück zum Zitat Brown C, Constance K, Bédard D, Purden M (2013) Colorectal surgery patients’ pain status, activities, satisfaction and beliefs about pain and pain management. Pain Manag Nurs 14(4):184–192PubMedCrossRef Brown C, Constance K, Bédard D, Purden M (2013) Colorectal surgery patients’ pain status, activities, satisfaction and beliefs about pain and pain management. Pain Manag Nurs 14(4):184–192PubMedCrossRef
25.
Zurück zum Zitat Hathaway D (1996) Effect of pre-operative instruction on post-operative outcomes: a meta-analysis. Nurs Res 35(5):269–275 Hathaway D (1996) Effect of pre-operative instruction on post-operative outcomes: a meta-analysis. Nurs Res 35(5):269–275
26.
Zurück zum Zitat Solberg LI (2000) Guideline implementation: what the literature doesn’t tell us. Jt Comm J Qual Improv 26(9):525–537PubMed Solberg LI (2000) Guideline implementation: what the literature doesn’t tell us. Jt Comm J Qual Improv 26(9):525–537PubMed
27.
Zurück zum Zitat Cabana MD, Rand CS, Powe NR et al (1999) Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 282(15):1458–1465PubMedCrossRef Cabana MD, Rand CS, Powe NR et al (1999) Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 282(15):1458–1465PubMedCrossRef
28.
Zurück zum Zitat Grimshaw JM, Russell IT (1993) Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 342:1317–1322PubMedCrossRef Grimshaw JM, Russell IT (1993) Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 342:1317–1322PubMedCrossRef
29.
Zurück zum Zitat Young GJ, Charns MP, Daley J et al (1997) Best practices for managing surgical services: the role of coordination. Health Care Manage Rev 22:72–81PubMedCrossRef Young GJ, Charns MP, Daley J et al (1997) Best practices for managing surgical services: the role of coordination. Health Care Manage Rev 22:72–81PubMedCrossRef
30.
Zurück zum Zitat Inouye SK, Peduzzi P, Robinson J, Hughes J, Horwifz R, Concat J (1998) Importance of functional measures in predicting mortality among older hospitalized patients. JAMA 279:1187–1193PubMedCrossRef Inouye SK, Peduzzi P, Robinson J, Hughes J, Horwifz R, Concat J (1998) Importance of functional measures in predicting mortality among older hospitalized patients. JAMA 279:1187–1193PubMedCrossRef
Metadaten
Titel
A Qualitative Study Assessing the Barriers to Implementation of Enhanced Recovery After Surgery
verfasst von
Alison Lyon
Michael J. Solomon
James D. Harrison
Publikationsdatum
01.06.2014
Verlag
Springer US
Erschienen in
World Journal of Surgery / Ausgabe 6/2014
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-013-2441-7

Weitere Artikel der Ausgabe 6/2014

World Journal of Surgery 6/2014 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.