Department of Thoracic Surgery, Albert Schweitzer Hospital, Dordrecht, Netherlands
Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Institute, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands.
BMJ Open. 2022 Jan 5;12(1):e051513. doi: 10.1136/bmjopen-2021-051513.
This study aims to elucidate determinants for succesful implementation of the Enhanced Recovery After Thoracic Surgery (ERATS) protocol for perioperative care for surgical lung cancer patients in the Netherlands.
Lung cancer operations are performed in both academic and regional hospitals, either by cardiothoracic or general thoracic surgeons. Limiting the impact of these operations by optimising and standardising perioperative care with the ERATS protocol is thought to enable reduction in length of stay, complications and costs.
A broad spectrum of stakeholders in perioperative care for patients with lung resection participated in this study, ranging from patient representatives, healthcare professionals to an insurance company representative.
Semistructured interviews (N=14) were conducted with the stakeholders (N=18). The interviews were conducted one on one by telephone and two times, face to face, in small groups. Verbatim transcriptions of these interviews were coded for the purpose of thematic analysis.
Determinants for successful implementation of the ERATS protocol in the Netherlands.
Several determinants correspond with previous publications: having a multidisciplinary team, leadership from a senior clinician and support from an ERAS-coordinator as facilitators; lack of feedback on performance and absence of management support as barriers. Our study underscores the potential detrimental effect of inconsistent communication, the lack of support in the transition from hospital to home and the barrier posed by lack of accessible audit data.
Based on a structured problem analysis among a wide selection of stakeholders, this study provides a solid basis for choosing adequate implementation strategies to introduce the ERATS protocol in the Netherlands. Emphasis on consistent and sufficient communication, support in the transition from hospital to home and adequate audit and feedback data, in addition to established implementation strategies for ERAS-type programmes, will enable a tailored approach to implementation of ERATS in the Dutch context.
本研究旨在阐明在荷兰成功实施胸外科围手术期增强康复（ERATS）方案的决定因素，以用于外科肺癌患者的围手术期护理。
肺癌手术在学术和地区医院进行，由心胸外科或普通胸外科医生进行。通过优化和标准化围手术期护理，使用 ERATS 方案限制这些手术的影响，有望减少住院时间、并发症和成本。
围手术期护理的广泛利益相关者参与了本研究，包括患者代表、医疗保健专业人员和保险公司代表。
对利益相关者（N=18）进行了半结构化访谈（N=14）。访谈通过电话一对一进行，两次在小组中面对面进行。对这些访谈的逐字记录进行了编码，以便进行主题分析。
几个决定因素与之前的出版物相对应：拥有多学科团队、由高级临床医生领导以及由 ERAS 协调员提供支持作为促进因素；缺乏绩效反馈和缺乏管理支持作为障碍。我们的研究强调了沟通不一致、医院到家庭过渡缺乏支持以及缺乏可访问的审计数据造成的潜在不利影响。
基于广泛选择的利益相关者之间的结构化问题分析，本研究为选择适当的实施策略提供了坚实的基础，以在荷兰引入 ERATS 方案。强调一致和充分的沟通、医院到家庭过渡的支持以及适当的审计和反馈数据，除了 ERAS 类型方案的既定实施策略外，将使 ERATS 在荷兰的实施能够采用量身定制的方法。
