Rapid Pre-Implementation Evaluation for Multi-Specialty Surgical Trials: Informing Context-Specific Adaptations

To demonstrate the application of the Consolidated Framework for Implementation Research (CFIR)-guided rapid qualitative methods for pre-implementation evaluation and adaptation of multi-specialty surgical trials.

CFIR-guided rapid qualitative methods have proven effective for pre-implementation evaluation in primary care, psychiatry, and critical care. However, their application to surgical contexts-where workflow complexity, specialty-specific practices, and time constraints present unique implementation challenges-remains unexplored.

We conducted CFIR-guided formative evaluation during the pre-implementation phase of a multisite hybrid type I trial that implemented multi-disciplinary frailty optimization across 21 surgical specialty clusters at 3 Veterans Affairs Medical Centers. We employed a multi-method approach including semistructured interviews with 30 stakeholders with surgical leaders, 6 focus groups with 24 PAUSE Board members, and multi-day on-site observations at 3 intervention sites (November 2021-June 2022). Data were analyzed using CFIR-informed rapid content analysis and triangulated to ensure rigor and actionability.

Rapid analysis identified implementation barriers and facilitators across CFIR domains, distinguishing between core intervention functions (frailty screening and multidisciplinary optimization) and adaptable elements (screening workflows, personnel roles, communication channels). This approach enabled site- and specialty-specific pre-implementation adaptations across all 21 clusters at 3 sites while aiming to preserve intervention fidelity.

This work provides a methodological roadmap for applying CFIR-guided rapid qualitative methods in multi-specialty surgical trials, demonstrating how systematic pre-implementation evaluation can balance fidelity with context-specific adaptation. Our approach offers practical guidance for researchers implementing complex interventions across diverse surgical specialties.