An ancillary study of implementation strategies used in surgical care: a scoping review

Improvement of surgical care is dependent upon successful implementation of evidence-based innovations. Implementation science (IS) uses strategies to promote the uptake of these innovations. The aim of this ancillary study, which was extracted from the data of an overview study of IS in surgical care, was to identify types and frequency of IS strategies used in surgical research, ascertain those strategies identified either before or after implementation, and identify strategies used in successfully implemented studies.

Using a modified version of the Arksey and O'Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews Checklist were used to identify IS strategies used in published surgical research from January 2001 to June 2023. Extraction of discrete strategies, which were identified as strategies by the original authors of the individual papers, was completed by two authors. Once extracted these strategies were mapped to the Expert Recommendation for Implementing Change (ERIC).

Seventy-three studies met the inclusion criteria. Five major strategies were identified: (1) education and training; (2) audit and feedback; (3) identifying and preparing champions; (4) assessing for readiness and barriers and facilitators; and (5) being able to adapt and tailor the innovation to the individual context. Most (69%) of the studies identifying strategies pre-implementation reported successful implementation processes and used evaluative and iterative strategies.

The findings of this scoping review provide insight into the implementation strategies, which may be useful for planning and executing future implementation studies in surgery. These results suggest that education, information sharing, and integrated process evaluations are important strategies to consider in surgical care implementation.