L.D. Jeong1, W.M. Oslock2,3, B.A. Jones4, I.I. Herbey2, G.A. Naik2, A.H. Harsono2, B.P. Smith2, D.I. Chu2, M.A. Rubyan5 1University Of Alabama at Birmingham, Heersink School Of Medicine, Birmingham, AL, USA 2University Of Alabama at Birmingham, Department Of Surgery, Birmingham, AL, USA 3Birmingham Veterans Affairs Medical Center, Department Of Quality, Birmingham, AL, USA 4University Of Texas Southwestern Medical Center, Department Of Surgery, Dallas, TX, USA 5University Of Michigan, School Of Public Health, Ann Arbor, MI, USA
Introduction:
Effective communication is essential in facilitating the successful adoption and improvement of Enhanced Recovery Programs (ERPs), which improve surgical recovery and post-operative outcomes when implemented appropriately. Given the need for interprofessional coordination and patient engagement to deliver individual ERP components, this study aimed to identify key communication barriers and facilitators when implementing ERPs in a tertiary-care hospital in the Deep South.
Methods:
Semi-structured interviews were conducted with healthcare professionals engaged in ERPs at a single institution to investigate factors influencing implementation across patient, team member, and institutional contexts. Participants were recruited using convenience and snowball sampling methods, and the interview guide was structured according to the theoretical domains framework, a widely used implementation science qualitative framework broadly applied across health domains. Four coders transcribed and analyzed interview data using NVivo 14, employing both inductive thematic and content analyses. A comprehensive codebook was established with a high inter-coder agreement rate of 90%, and data saturation was ensured through the constant comparative method.
Results:
This study included 32 interdisciplinary healthcare team members including nurses (n=18), surgeons (n=5), anesthesiologists (n=3), physical and occupational therapists (n=2), a pharmacist (n=1), and other ERP-engaged professionals (n=3). The mean age of participants was 44.5 years, and the median years of participants’ experience working with ERPs was 5-9 years. Participants identified both barriers and facilitators at the patient, team member, and institutional levels. Quotes from participants and subthemes of communicative barriers and facilitators were identified, as shown in Figure 1. Notable barriers included time restraint, lack of internal communication, and a tendency to rush. Key facilitators in communication for successful ERP implementation included engagement with caregivers, standardized communication, and additional efforts for patients with low health literacy.
Conclusion:
Critical barriers to communication exist that limit successful ERP implementation, including inconsistent terminology for ERP at the institutional level. Thus, leveraging facilitators like engagement with caregivers and standardized communication are pivotal for successful ERP integration. These insights from healthcare providers contribute to advancing evidence-based practices and optimizing patient outcomes.