L. J. Kreutzer1, M. F. McGee1,2,3, S. Oberoi3, K. Y. Bilimoria1,2,3, J. K. Johnson1,2 1Northwestern University,Surgical Outcomes And Quality Improvement Center,Chicago, IL, USA 2Feinberg School Of Medicine – Northwestern University,Chicago, IL, USA 3Northwestern Memorial Hospital,Chicago, IL, USA
Introduction: Enhanced Recovery After Surgery (ERAS) is an evidence-based intervention to improve patient outcomes, yet hospitals often underestimate the complexity of implementation. To be most effective, the intervention needs to be context-specific and often requires adaptations so that it is appropriate to the setting and available resources. Organizational and unit-level readiness for change, including the extent to which organizational members are prepared to implement a new intervention, is often overlooked. Our objective was to develop and test a tool to assess hospital readiness to implement ERAS for patients undergoing colorectal procedures.
Methods: We developed a Readiness to Implement Core Components of Enhanced Recovery (RECOVER) Tool based on a literature review and our prior experience implementing ERAS. The RECOVER Tool is dual purpose, designed to (1) provide a practical planning tool for the implementation team and (2) collect baseline data of hospital willingness and perceived ability to change practice. The RECOVER Tool includes 4 sections. Section 1 captures information about the hospital’s implementation task force. Section 2 inventories the components of ERAS and identifies implementation willingness. Sections 3 and 4 use a 5-point Likert scale of agreement to assess areas where the task force perceives a need for guidance in implementation and where individual units may need assistance in implementation and in changing behavior. Five hospitals within one health system were asked to complete the RECOVER Tool. Sections 1 and 2 were emailed to representatives from each hospital for completion. Members of the task force from each hospital received sections 3 and 4 through REDCap.
Results: The response rate for sections 1 and 2 was 100%. Of the task force members who received a link to complete sections 3 and 4 through REDCap, 60.3% (44 out of 73) completed the survey. The hospital-specific survey response rates ranged from 46.2% to 66.7%.
All hospitals indicated willingness to implement ERAS. Four of the five hospitals struggled with: 1) setting specific goals for implementing ERAS; 2) assigning or clarifying task force roles; 3) gaining buy-in from leadership, 4) engaging IT; and 5) engaging analytics/statistical support.
At the department-level, perceptions of readiness were strong overall across departments; however, one hospital department identified a need to strengthen the ability to adapt quickly when making changes to the way the department works.
Conclusion: Assessing readiness to implement a complex intervention, such as ERAS, provides an opportunity to gain insight into perceived barriers to implementation. Furthermore, tools can be tailored to strengthen targeted areas to support hospitals’ implementation process by giving insight into key implementation outcomes: acceptability, feasibility, and appropriateness.