Barriers and Facilitators to Enhanced Recovery Protocol Implementation for Neonatal Intestinal Surgery

Area of Science:

• Pediatric Surgery
• Enhanced Recovery Protocols
• Neonatal Care

Background:

• The Enhanced Recovery After Surgery (ERAS) Society released guidelines in 2020 to reduce physiological stress in neonates undergoing intestinal surgery.
• This study investigates how stakeholders perceive the adoption and acceptability of a neonatal ERAS protocol, identifying implementation barriers and facilitators.

Purpose of the Study:

• To explore stakeholder perceptions regarding the acceptability and adoption of a neonatal enhanced recovery protocol.
• To identify barriers and facilitators influencing the implementation of ERAS guidelines in neonatal intestinal surgery.

Main Methods:

• Seven semistructured focus groups were conducted with 36 diverse stakeholders from six US hospitals.
• Transcripts were analyzed using MAXQDA with a combined inductive and deductive approach, followed by thematic analysis.

Main Results:

• Protocol implementation varied, with high adoption of some elements (e.g., breast milk nutrition) but low acceptance of others (e.g., early enteral feeds).
• Five key themes emerged: heterogeneity of the neonatal surgical population, competing stakeholder priorities, care coordination across teams, clarity of component definitions, and openness to practice change.

Conclusions:

• A preimplementation assessment revealed specific needs for neonatal intestinal surgery ERAS protocols.
• Effective implementation necessitates consensus on the target population, stakeholder alignment, improved care coordination, refined definitions, and greater adaptability to practice changes.