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Methodology for implementing early recovery after surgery protocols in colorectal surgery


Authors: P. Kocian 1;  F. Pazdírek 1;  M. Vjaclovský 1;  M. Bockova 1;  A. Stolz 1;  D. Hodyc 2
Authors‘ workplace: Chirurgická klinika 2. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Motole, Praha, Česká republika 1;  Advance Healthcare Management Consulting, Praha, Česká republika 2
Published in: Rozhl. Chir., 2023, roč. 102, č. 7, s. 268-276.
Category: Original articles
doi: https://doi.org/10.33699/PIS.2023.102.7.268–276

Overview

Introduction: Enhanced recovery after surgery (ERAS) protocols in colorectal surgery leads to improved quality of care and more efficient resource utilization. Despite these positive outcomes, the penetration of ERAS protocols in the Czech Republic is low. The aim of this study is to present a general methodology for implementing an ERAS protocol in colorectal surgery.

Methods: The methodology is based on the authors’ extensive experience in implementing clinical protocols at various institutions in the Czech Republic, as well as published international experiences. This methodology is described in detail and supplemented with data obtained during implementation of an ERAS program at the author’s institution.

Results: The preparatory phase includes in-depth quality of care audits and preparation of an ERAS protocol. The purpose of the audits is to identify areas of care where standardization or targeted changes in clinical practice are desirable. The implementation phase involves staff training, technical implementation support, protocol dissemination, adherence monitoring, and evaluation of a pilot phase with subsequent protocol adjustments. The evaluation phase involves data collection, maintaining a prospective database, and regular assessments.

Conclusion: The presented methodology describes the individual steps in the process of implementing a clinical protocol into practice. This text can serve as a manual for implementing an ERAS protocol in colorectal surgery at any institution.

Keywords:

ERAS – colorectal surgery – methodology – implementation – clinical protocol


Sources
  1. Greco M, Capretti G, Beretta L, et al. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg. 2014;38(06):1531–1541. doi:10.1007/s00268-013-2416-8.
  2. Varadhan KK, Neal KR, Dejong CH, et al. The enhanced recovery after surgery (ERAS) for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010;29(04):434–440. doi:10.1016/j.clnu.2010.01.004.
  3. Thanh NX, Chuck AW, Wasylak T, et al. An economic evaluation of the enhanced Rrecovery after surgery (ERAS) multisite implementation program for colorectal surgery in Alberta. Can J Surg. 2016 Dec 1;59(6):415-421. doi:10.1503/cjs.006716.
  4. Ryska O, Šerclová Z, Antoš F. Jak jsou dodržovány postupy moderní perioperační péče (enhanced recovery after surgery) na chirurgických pracovištích v ČR – výsledky národní ankety. Rozhl Chir. 2013;92:435−442.
  5. Conn LG, McKenzie M, Pearsall EA, et al. Successful implementation of an enhanced recovery after surgery programme for elective colorectal surgery: a process evaluation of champions’ experiences. Implement Sci. 2015;99:10. doi:10.1186/ s13012-015-0289.
  6. Pagano E, Pellegrino L, Rinaldi F, et al. Implementation of the ERAS (enhanced recovery after surgery) protocol for colorectal cancer surgery in the Piemonte Region with an audit and feedback approach: study protocol for a stepped wedge cluster randomised trial: a study of the EASY-NET project. BMJ Open 2021;11(6):e047491.  doi:10.1136/bmjo-pen-2020-047491.
  7. Nelson G, Wang X, Nelson A, et al. Evaluation of the implementation of multiple enhanced recovery after surgery pathways across a provincial health care system in Alberta, Canada. JAMA Netw Open 2021;4(8):e2119769. doi:10.1001/jamanetworkopen.2021.19769.
  8. Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced recovery after surgery (ERAS®) Society recommendations: 2018. World J Surg. 2019;43:659−695. doi.org/10.1007/s00268-018-4844-y.
  9. Lam JY, Howlett A, McLuckie D, et al. Developing implementation strategies to adopt enhanced recovery after surgery (ERAS®) guidelines. BJS Open 2021 5;5(2):zraa011. doi:10.1093/bjsopen/zraa011.
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Surgery Orthopaedics Trauma surgery
Topics Journals
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