Enhanced Recovery after Surgery (ERAS) Implementation and Barriers among Healthcare Providers in France: A Cross-Sectional Study
The implementation of Enhanced Recovery After Surgery (ERAS) is a challenge for healthcare systems, especially in case of patients undergoing major surgery. Despite a proven significant reduction in postoperative complications and hospital lengths of stay, ERAS protocols are inconsistently used in r...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-02-01
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| Series: | Healthcare |
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| Online Access: | https://www.mdpi.com/2227-9032/12/4/436 |
| _version_ | 1797298129831198720 |
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| author | Augustin Clet Marin Guy Jean-François Muir Antoine Cuvelier Francis-Edouard Gravier Tristan Bonnevie |
| author_facet | Augustin Clet Marin Guy Jean-François Muir Antoine Cuvelier Francis-Edouard Gravier Tristan Bonnevie |
| author_sort | Augustin Clet |
| collection | DOAJ |
| description | The implementation of Enhanced Recovery After Surgery (ERAS) is a challenge for healthcare systems, especially in case of patients undergoing major surgery. Despite a proven significant reduction in postoperative complications and hospital lengths of stay, ERAS protocols are inconsistently used in real-world practice, and barriers have been poorly described in a cohort comprising medical and paramedical professionals. This study aims to assess the proportion of French healthcare providers who practiced ERAS and to identify barriers to its implementation amongst those surveyed. We conducted a prospective cross-sectional study to survey healthcare providers about their practice of ERAS using an online questionnaire. Healthcare providers were contacted through hospital requests, private hospital group requests, professional corporation requests, social networks, and personal contacts. The questionnaire was also designed to explore barriers to ERAS implementation. Identified barriers were allocated by two independent assessors to one of the fourteen domains of the Theoretical Domains Framework (TDF), which is an integrative framework based on behavior change theories that can be used to identify issues relating to evidence on the implementation of best practice in healthcare settings. One hundred and fifty-three French healthcare providers answered the online questionnaire (76% female, median age 35 years (IQR: 29 to 48)). Physiotherapists, nurses, and dieticians were the most represented professions (31.4%, 24.2%, and, 14.4%, respectively). Amongst those surveyed, thirty-one practiced ERAS (20.3%, 95%CI: 13.9 to 26.63). Major barriers to ERAS practice were related to the “Environmental context and resources” domain (57.6%, 95%CI: 49.5–65.4), e.g., lack of professionals, funding, and coordination, and the “Knowledge” domain (52.8%, 95%CI: 44.7–60.8), e.g., ERAS unawareness. ERAS in major surgery is seldom practiced in France due to the unfavorable environment (i.e., logistics issues, and lack of professionals and funding) and a low rate of procedure awareness. Future studies should focus on devising and assessing strategies (e.g., education and training, collaboration, institutional support, the development of healthcare networks, and leveraging telehealth and technology) to overcome these barriers, thereby promoting the wider implementation of ERAS. |
| first_indexed | 2024-03-07T22:30:24Z |
| format | Article |
| id | doaj.art-3339543c94d849919bcfd0dfd2a2bff3 |
| institution | Directory Open Access Journal |
| issn | 2227-9032 |
| language | English |
| last_indexed | 2024-03-07T22:30:24Z |
| publishDate | 2024-02-01 |
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| record_format | Article |
| series | Healthcare |
| spelling | doaj.art-3339543c94d849919bcfd0dfd2a2bff32024-02-23T15:18:14ZengMDPI AGHealthcare2227-90322024-02-0112443610.3390/healthcare12040436Enhanced Recovery after Surgery (ERAS) Implementation and Barriers among Healthcare Providers in France: A Cross-Sectional StudyAugustin Clet0Marin Guy1Jean-François Muir2Antoine Cuvelier3Francis-Edouard Gravier4Tristan Bonnevie5Université Rouen Normandie, Normandie Univ, GRHVN UR 3830, F-76000 Rouen, FranceCentre Aquitain Du Dos, Hôpital Privé Saint-Martin, F-33600 Pessac, FranceUniversité Rouen Normandie, Normandie Univ, GRHVN UR 3830, F-76000 Rouen, FranceADIR Association, Rouen University Hospital, F-76000 Rouen, FranceUniversité Rouen Normandie, Normandie Univ, GRHVN UR 3830, F-76000 Rouen, FranceUniversité Rouen Normandie, Normandie Univ, GRHVN UR 3830, F-76000 Rouen, FranceThe implementation of Enhanced Recovery After Surgery (ERAS) is a challenge for healthcare systems, especially in case of patients undergoing major surgery. Despite a proven significant reduction in postoperative complications and hospital lengths of stay, ERAS protocols are inconsistently used in real-world practice, and barriers have been poorly described in a cohort comprising medical and paramedical professionals. This study aims to assess the proportion of French healthcare providers who practiced ERAS and to identify barriers to its implementation amongst those surveyed. We conducted a prospective cross-sectional study to survey healthcare providers about their practice of ERAS using an online questionnaire. Healthcare providers were contacted through hospital requests, private hospital group requests, professional corporation requests, social networks, and personal contacts. The questionnaire was also designed to explore barriers to ERAS implementation. Identified barriers were allocated by two independent assessors to one of the fourteen domains of the Theoretical Domains Framework (TDF), which is an integrative framework based on behavior change theories that can be used to identify issues relating to evidence on the implementation of best practice in healthcare settings. One hundred and fifty-three French healthcare providers answered the online questionnaire (76% female, median age 35 years (IQR: 29 to 48)). Physiotherapists, nurses, and dieticians were the most represented professions (31.4%, 24.2%, and, 14.4%, respectively). Amongst those surveyed, thirty-one practiced ERAS (20.3%, 95%CI: 13.9 to 26.63). Major barriers to ERAS practice were related to the “Environmental context and resources” domain (57.6%, 95%CI: 49.5–65.4), e.g., lack of professionals, funding, and coordination, and the “Knowledge” domain (52.8%, 95%CI: 44.7–60.8), e.g., ERAS unawareness. ERAS in major surgery is seldom practiced in France due to the unfavorable environment (i.e., logistics issues, and lack of professionals and funding) and a low rate of procedure awareness. Future studies should focus on devising and assessing strategies (e.g., education and training, collaboration, institutional support, the development of healthcare networks, and leveraging telehealth and technology) to overcome these barriers, thereby promoting the wider implementation of ERAS.https://www.mdpi.com/2227-9032/12/4/436ERAShealthcare providerspracticebarriers |
| spellingShingle | Augustin Clet Marin Guy Jean-François Muir Antoine Cuvelier Francis-Edouard Gravier Tristan Bonnevie Enhanced Recovery after Surgery (ERAS) Implementation and Barriers among Healthcare Providers in France: A Cross-Sectional Study Healthcare ERAS healthcare providers practice barriers |
| title | Enhanced Recovery after Surgery (ERAS) Implementation and Barriers among Healthcare Providers in France: A Cross-Sectional Study |
| title_full | Enhanced Recovery after Surgery (ERAS) Implementation and Barriers among Healthcare Providers in France: A Cross-Sectional Study |
| title_fullStr | Enhanced Recovery after Surgery (ERAS) Implementation and Barriers among Healthcare Providers in France: A Cross-Sectional Study |
| title_full_unstemmed | Enhanced Recovery after Surgery (ERAS) Implementation and Barriers among Healthcare Providers in France: A Cross-Sectional Study |
| title_short | Enhanced Recovery after Surgery (ERAS) Implementation and Barriers among Healthcare Providers in France: A Cross-Sectional Study |
| title_sort | enhanced recovery after surgery eras implementation and barriers among healthcare providers in france a cross sectional study |
| topic | ERAS healthcare providers practice barriers |
| url | https://www.mdpi.com/2227-9032/12/4/436 |
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