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. 2024 Mar 13;24(1):330.
doi: 10.1186/s12913-024-10837-z.

Views and experiences of healthcare professionals and patients on the implementation of a 23-hour accelerated enhanced recovery programme: a mixed-method study

Misha A T Sier  1   2 , Eva Godina  3   4 , Thaís T T Tweed  5   6 , Imane Daher  7 , Jan H M B Stoot  3
Affiliations

Views and experiences of healthcare professionals and patients on the implementation of a 23-hour accelerated enhanced recovery programme: a mixed-method study

Misha A T Sier et al. BMC Health Serv Res. .

Abstract

Background: An accumulating body of research suggests that an accelerating enhanced recovery after colon surgery protocol is beneficial for patients, however, to obtain these effects, adherence to all elements of the protocol is important. The implementation of complex interventions, such as the Enhanced Recovery After Surgery protocol (ERAS), and their strict adherence have proven to be difficult. The same challenges can be expected in the implementation of the accelerated Enhanced Recovery Pathways (ERPs). This study aimed to understand the perspectives of both healthcare professionals (HCPs) and patients on the locally studied acCelerated enHanced recovery After SurgEry (CHASE) protocol.

Methods: For this mixed-method study, HCPs who provided CHASE care and patients who received CHASE care were recruited using purposive sampling. Ethical approval was obtained by the Medical Ethical Committee of the Zuyderland Medical Centre (NL71804.096.19, METCZ20190130, October 2022). Semi-structured, in-depth, one-on-one interviews were conducted with HCPs (n = 13) and patients (n = 11). The interviews consisted of a qualitative and quantitative part, the protocol evaluation and the Measurement Instrument or Determinant of Innovations-structured questionnaire. We explored the perspectives, barriers, and facilitators of the CHASE protocol implementation. The interviews were audiotaped, transcribed verbatim and analysed independently by two researchers using direct content analysis.

Results: The results showed that overall, HCPs support the implementation of the CHASE protocol. The enablers were easy access to the protocol, the relevance of the intervention, and thorough patient education. Some of the reported barriers included the difficulty of recognizing CHASE patients, the need for regular feedback, and the updates on the implementation progress. Most patients were enthusiastic about early discharge after surgery and expressed satisfaction with the care they received. On the other hand, the patients sometimes received different information from different HCPs, considered the information to be too extensive and few experienced some discomfort with CHASE care.

Conclusion: Bringing CHASE care into practice was challenging and required adaptation from HCPs. The experiences of HCPs showed that the protocol can be improved further, and the mostly positive experiences of patients are a motivation for this improvement. These results yielded practical implications to improve the implementation of accelerated ERPs.

Keywords: Accelerated recovery; Colorectal cancer surgery; Health care professional perspective; Patient perspective; Perioperative cancer care.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Answers on CHASE intervention determinants
Fig. 2
Fig. 2
Answers on CHASE user determinants
Fig. 3
Fig. 3
Answers on CHASE user determinants—colleagues
Fig. 4
Fig. 4
Answers on socio-politic context determinants – presence coordinator
See this image and copyright information in PMC

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References

    1. Basse L, Thorbøl JE, Løssl K, Kehlet H. Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum. 2004;47:271–278. doi: 10.1007/s10350-003-0055-0. - DOI - PubMed
    1. Gustafsson U, Scott M, Hubner M, Nygren J, Demartines N, Francis N, Rockall T, Young-Fadok T, Hill A, Soop M, de Boer H, Urman R, Chang G, Fichera A, Kessler H, Grass F, Whang E, Fawcett W, Carli F, Lobo D, Rollins K, Balfour A, Baldini G, Riedel B, Ljungqvist O. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J Surg. 2019;43:659–695. doi: 10.1007/s00268-018-4844-y. - DOI - PubMed
    1. Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J. Adherence to the Enhanced Recovery After Surgery Protocol and Outcomes After Colorectal Cancer Surgery. Archives of surgery (Chicago. 1960) 2011;146:571–577. doi: 10.1001/archsurg.2010.309. - DOI - PubMed
    1. Cakir H, van Stijn MFM, Lopes Cardozo AMF, Langenhorst BLAM, Schreurs WH, van der Ploeg TJ, Bemelman WA, Houdijk APJ. Adherence to enhanced recovery after surgery and length of stay after colonic resection. Colorectal Dis. 2013;15:1019–1025. doi: 10.1111/codi.12200. - DOI - PubMed
    1. Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006;26:13–24. doi: 10.1002/chp.47. - DOI - PubMed

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