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Implementing Enhanced Recovery Pathways: A Qualitative Study of Factors That Distinguished Higher Performing
Christina T Yuan1,2, JunBo Wu1, Chelsea P Cardell3
1Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD.
Annals of Surgery
|December 5, 2023
Summary
Successful implementation of enhanced recovery pathways requires effective information sharing, planning, and engagement. Positive clinician beliefs and strong leadership support are key to improving adherence to these surgical care protocols.
Area of Science:
- Healthcare Management
- Implementation Science
- Perioperative Medicine
Background:
- Enhanced recovery pathways (ERPs) are clinically effective but show variable implementation success.
- Understanding factors differentiating high from low ERP implementation is crucial.
Purpose of the Study:
- To explore barriers and facilitators impacting ERP implementation.
- To identify factors distinguishing hospitals with higher implementation success.
Main Methods:
- In-depth interviews with 168 perioperative leaders and staff across 8 US hospitals.
- Thematic analysis guided by the Consolidated Framework for Implementation Research.
- Assessment of implementation success based on adherence to 9 process measures over time.
Main Results:
- Positive factors: information sharing, planning, and engaging. Negative factors: pathway complexity, infrastructure, and execution (especially EHR changes).
- High-performing hospitals had positive clinician knowledge/beliefs and strong leadership support.
- Clinician engagement and executive backing were critical for success.
Conclusions:
- Qualitative insights reveal key factors associated with successful ERP implementation.
- Diverse perioperative perspectives highlight the importance of communication and leadership.
- Addressing pathway complexity and infrastructure challenges is vital for widespread adoption.
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