A qualitative examination of barriers and facilitators of pediatric enhanced recovery protocol implementation among 18 pediatric surgery services.
Davis TL, Schäfer WLA, Blake SC, Close S, Balbale SN, Perry JE, Zarate RP, Ingram M, Strople J, Johnson JK, Holl JL, Raval MV
Enhanced recovery protocols (ERPs) for gastrointestinal surgery result in shorter lengths of stay, shortened time to regular diet, and fewer opioids. This study evaluates ERP implementation at 18 US hospitals with pediatric surgery services. We conducted semi-structured interviews with 48 pediatric surgeons, anesthesiologists, gastroenterologists, nurses, and physician assistants. Facilitators for effective practices included standardized protocols and organizational support, while barriers included a lack of compliance. Facilitators for effective implementation were checklists, protected time to oversee ERPs, and electronic medical record order sets; barriers included having no formal ERP team. Facilitators for enabling context were having a multidisciplinary team and patient/family engagement, and a barrier was having limited team buy-in. ERP implementation in pediatric surgery needs team-based support for change management and protocols for developing an ERP implementation team.