Requirements for a successful Enhanced Recovery After Surgery (ERAS) program: a multicenter international survey among ERAS nurses

Abstract

Summary Introduction Nurses are the linchpin of any Enhanced Recovery After Surgery (ERAS) program, as they are in direct contact with patients and various caregivers. The aim of the present survey was to assess ERAS key factors and challenges from a nurse’s perspective. Methods A qualitative study among ERAS dedicated nurses and ERAS Interactive Audit System (EIAS) administrators using an online questionnaire (Survey Monkey®, Palo Alto, CA, United States) comprising 29 questions. The survey focused on challenges and drawbacks encountered during ERAS training, implementation and daily clinical practice. Closed multiple-choice and open-end questions and semantic differential scales (0–10) were used. Those invited to participate received three reminders within 4 and 8 weeks after invitation. Results Of 306 nurses invited, 123 completed the survey (response rate 40%). Overall, the success of the institutional ERAS program was rated as 6.9 ± 2/10. Improving both patient outcomes (90%) and satisfaction (69%) were rated as main motivators for ERAS implementation, while time restraints (50%) and logistics (43%) were identified as the main barriers. The study revealed a wide heterogeneity in coordination and management strategies (ERAS meetings, work models, teaching strategies). Sustained staff education before (9.1/10) and after (9.1/10) implementation, a dedicated ERAS coordinator (8.9/10) and regular meetings (8.3/10 scale) were rated as key factors for a successful program. Difficulty of implementation, maintenance and data acquisition were all rated > 5/10. Conclusion Despite heterogeneity in coordination and management, the ERAS program is evaluated as successful from a nurse’s perspective. Continuous staff education and coordination beyond the implementation period appear to be of the utmost importance for a sustained program.