Related Experiment Video
Updated: Jan 15, 2026
Author Spotlight: Implementing the Enhanced Recovery After Surgery Concept in Rehabilitation Following Anterior Cruciate Ligament Reconstruction
Published on: March 1, 2024
A Study of Various Barriers in Implementing "Enhanced Recovery After Cardiac Surgery (ERACS)" Program in Indian Setup
Krishna Prasad P Gourav1, Virendra K Arya1, Komal A Gandhi1
1Department of Anesthesia and intensive care, PGIMER, Chandigarh, India.
Background:
To observe the compliance rate for enhanced recovery after cardiac surgery (ERACS) protocols and various barriers involved in its non-compliance.
Methods:
A Prospective observational study conducted in a single quaternary teaching hospital. Patients older than 18 years undergoing major cardiac surgery were asked to follow an ERACS protocol in the perioperative period. A 19-point ERACS protocol was implemented in 577 patients, involving 8,041 active interventions. The barriers involved in its noncompliance were studied.
Results:
The overall compliance rate was 66.7%, with complete adherence to the preoperative checklist. However, debriefing had the lowest compliance and was omitted entirely. Analysis of non-compliance revealed nine key barriers, with the most common being resistance to changing established practices (46.1%), followed by lack of motivation (13.7%) and insufficient knowledge or training (12%). The least frequent barrier was lack of conflict resolution (0.6%). Proper handover significantly reduced mechanical ventilation duration (9.4 vs. 14.1 hours, p = 0.002) and ICU stay (4.9 vs. 6.1 days, p < 0.001).
Conclusions:
Nine key barriers to adherence were identified. Mental inertia (46.1%) is the most common barrier to practice change found in our study, followed by a lack of motivation among staff members (13.7%). Addressing these challenges is crucial for improving ERACS implementation and optimizing patient outcomes.
