Interdepartmental Spread of Innovations: A Multicentre Study of the Enhanced Recovery After Surgery Programme

Jeanny J. A. de Groot*, Jose M. C. Maessen, Cornelis H. C. Dejong, Bjorn Winkens, Roy F. P. M. Kruitwagen, Brigitte F. M. Slangen, Trudy van der Weijden

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Spread of evidence-based innovations beyond pioneering settings is essential to improve quality of care. This study aimed to evaluate the influence of a national project to implement 'Enhanced Recovery After Surgery' (ERAS) among colorectal teams on the spread of this innovation to gynaecological procedures.

A retrospective observational multicentre study was performed of a consecutive sample of patients who underwent major elective gynaecological surgery in 2012-2013. Ten Dutch hospitals (294 patients) had participated in a colorectal breakthrough project implementing ERAS on a nationwide basis and were assigned to the intervention group. Thirteen hospitals (390 patients) that had not participated in this project acted as controls. Outcome measures were time to functional recovery and total length of postoperative hospital stay. Multilevel models adjusted for clustering and baseline demographics were used for analysis. The uptake of ten selected perioperative care elements was evaluated for each hospital.

The estimated mean difference (95% confidence interval) between the intervention and control hospitals was -0.3 (-0.9 to 0.3) days in the time to recovery and 0.2 (-0.8 to 1.3) days in the total length of hospital stay. The mean (+/- standard deviation) absolute rate of implemented perioperative care elements per hospital was 28.9 +/- 14.9% in the control, versus 29.3 +/- 11.1% in the intervention group (p = 0.934).

Initial implementation effects seem to be restricted to the participating teams and do not automatically spread to other surgical teams in the same hospital.

Original languageEnglish
Pages (from-to)2348-2355
Number of pages8
JournalWorld Journal of Surgery
Volume42
Issue number8
DOIs
Publication statusPublished - Aug 2018

Keywords

  • ERAS(R) SOCIETY RECOMMENDATIONS
  • ELECTIVE COLONIC SURGERY
  • RADICAL HYSTERECTOMY
  • GYNECOLOGIC ONCOLOGY
  • COLORECTAL SURGERY
  • PERIOPERATIVE CARE
  • PELVIC LYMPHADENECTOMY
  • QUALITY IMPROVEMENT
  • PATIENT SAFETY
  • HEALTH-CARE
  • Length of Stay
  • Outcome Assessment (Health Care)
  • Humans
  • Middle Aged
  • Gynecologic Surgical Procedures
  • Male
  • Recovery of Function
  • Perioperative Care/methods
  • Female
  • Aged
  • Retrospective Studies
  • Elective Surgical Procedures
  • Quality of Health Care

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