Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden.
Clin Nutr. 2018 Dec;37(6 Pt A):2172-2177. doi: 10.1016/j.clnu.2017.10.017. Epub 2017 Oct 31.
BACKGROUND & AIMS: The existence of enhanced recovery specific guidelines (ERAS) is not enough to change patient management practice since many barriers exist to successful ERAS implementation. The present survey aimed to analyse motivations for implementation as well as encountered difficulties and challenges. Further, relevance and importance of perioperative care items and postoperative recovery targets were assessed. METHODS: A multicentre qualitative study was conducted between August and December 2016 among surgeons, anaesthesiologists and nurses from implemented ERAS centres in Switzerland (n = 16) and Sweden (n = 14). An online survey (31 closed questions) was sent by email, with reminders at 4, 8 and 12 weeks. RESULTS: Seventy-seven out of 146 experts completed the survey (response rate 52.7%). Main motivations to implement ERAS were the expectation to reduce complications (91%), higher patient satisfaction (73%) and shorter hospital stay (62%). The application of ERAS program represented major changes in clinical practice for 57% of participants without significant differences between various specialities (surgeons: 63%, nurses: 63%, anaesthesiologists: 36%, p = 0.185). The most important barriers for straightforward implementation were time restraints (69%), opposing colleagues (68%) and logistical reasons (66%). The 3 most frequently cited patient-related barriers to adopt ERAS were opposing personality (52%), co-morbidities (49%) and language barriers (31%). CONCLUSIONS: Implementing ERAS care into practice was challenging and required important changes in clinical practice for all involved specialities. Main reasons for implementation were the expectation to reduce complications and hospital stay with improved patients' satisfaction. Main barriers were time restraints, reluctance to change and logistics.
背景与目的:尽管存在特定的加速康复指南(ERAS),但要改变患者管理实践仍存在许多障碍,因此这还不足以成功实施 ERAS。本调查旨在分析实施的动机,以及遇到的困难和挑战。此外,还评估了围手术期护理项目和术后恢复目标的相关性和重要性。
方法:2016 年 8 月至 12 月,在瑞士(n=16)和瑞典(n=14)实施 ERAS 中心的外科医生、麻醉师和护士中进行了一项多中心定性研究。通过电子邮件发送在线调查(31 个封闭问题),并在第 4、8 和 12 周进行提醒。
结果:146 名专家中有 77 名完成了调查(应答率为 52.7%)。实施 ERAS 的主要动机是期望减少并发症(91%)、提高患者满意度(73%)和缩短住院时间(62%)。ERAS 方案的应用代表了临床实践的重大变化,其中 57%的参与者没有不同专业之间的显著差异(外科医生:63%,护士:63%,麻醉师:36%,p=0.185)。实施过程中最主要的障碍是时间限制(69%)、反对的同事(68%)和后勤原因(66%)。患者方面实施 ERAS 的 3 个最常被提及的障碍是性格对立(52%)、合并症(49%)和语言障碍(31%)。
结论:将 ERAS 护理实施到实践中具有挑战性,需要所有相关专业在临床实践中进行重大改变。实施的主要原因是期望减少并发症和住院时间,同时提高患者的满意度。主要障碍是时间限制、不愿意改变和后勤问题。
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