The Use of Sequential Surveys to Shorten Implementation Time for Healthcare System-Level Enhanced Recovery After Surgery (ERAS) Pathways

Public Deposited
Analytics

Downloadable Content

Download PDF
Request Version for Screen Reader
Creator
  • Adams, Ursula C.
  • Moulthrop, Amy J.
    • Affiliation: School of Medicine
  • Malay, Brendan
    • Other Affiliation: UNC Health, Care Redesign, Chapel Hill, NC, USA
  • Straube, Lacey E.
    • Affiliation: School of Medicine
  • McNaull, Peggy P.
    • Affiliation: School of Medicine
  • McGinigle, Katharine L.
    • Affiliation: School of Medicine
  • Phillips, Michael R.
    • Affiliation: School of Medicine
Abstract
  • Background Enhanced Recovery After Surgery (ERAS) pathways improve healthcare quality, safety, and cost-effectiveness. We hypothesized that the RAND Method (a hybrid Delphi approach), involving anonymous sequential surveys and face-to-face meetings, would allow for more rapid agreement and initiation of new ERAS pathways. Methods Using the ERAS Society guidelines for cesarean section as a baseline, our institution’s ERAS Leadership Team (ELT) compiled published literature and institutional practices to design a 32-component survey that was sent to obstetricians, nurse midwives, anesthesiologists, pharmacists, and nurses. Components that did not reach 90% consensus were included in a second survey the following week, and meetings were held to review results. At the conclusion of this process, time to agreement was retrospectively compared to the colorectal ERAS pathway process at this institution. Results ERAS pathway components were compiled and reviewed by 121 stakeholders at 7 hospitals using iterative surveys with review meetings over a 13-week period. Survey response rates were 61% and 50% in the initial and follow-up surveys, respectively. There was agreement on 28/32 and 32/32 items on the initial and follow-up surveys. Using the RAND Method, time to agreement decreased by 54.1% (24 vs 13 weeks) compared to prior system-wide efforts to standardize the colorectal surgery ERAS pathway. Discussion With rapidly expanding healthcare systems, effective methods to gain consensus and adopt ERAS pathways are critical to implementation of ERAS guidelines. We demonstrate that the RAND Method allows for a transparent and efficient means of agreement across a diverse group of clinicians practicing in several settings.
Date of publication
Keyword
DOI
Identifier
Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • Southeastern Surgical Congress
License
  • Attribution-NonCommercial 4.0 International
Journal title
  • The American Surgeon™
Journal volume
  • 89
Journal issue
  • 12
Page start
  • 5466
Page end
  • 5473
ISSN
  • 1555-9823
  • 0003-1348
Copyright date
  • 2023
Publisher
  • SAGE Publications

Relations

Parents:

This work has no parents.

In Collection:

Items

Thumbnail Title Date Uploaded Visibility Actions
file details 10.1177_00031348231156765.pdf 2024-01-11 Public Download