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World Journal of Surgery

, Volume 42, Issue 7, pp 1919–1928 | Cite as

Consensus on Training and Implementation of Enhanced Recovery After Surgery: A Delphi Study

  • Nader K. Francis
  • Thomas Walker
  • Fiona Carter
  • Martin Hübner
  • Angela Balfour
  • Dorthe Hjort Jakobsen
  • Jennie Burch
  • Tracy Wasylak
  • Nicolas Demartines
  • Dileep N. Lobo
  • Valerie Addor
  • Olle Ljungqvist
Original Scientific Report

Abstract

Background

Enhanced Recovery After Surgery (ERAS) is widely accepted in current surgical practice due to its positive impact on patient outcomes. The successful implementation of ERAS is challenging and compliance with protocols varies widely. Continual staff education is essential for successful ERAS programmes. Teaching modalities exist, but there remains no agreement regarding the optimal training curriculum or how its effectiveness is assessed. We aimed to draw consensus from an expert panel regarding the successful training and implementation of ERAS.

Methods

A modified Delphi technique was used; three rounds of questionnaires were sent to 58 selected international experts from 11 countries across multiple ERAS specialities and multidisciplinary teams (MDT) between January 2016 and February 2017. We interrogated opinion regarding four topics: (1) the components of a training curriculum and the structure of training courses; (2) the optimal framework for successful implementation and audit of ERAS including a guide for data collection; (3) a framework to assess the effectiveness of training; (4) criteria to define ERAS training centres of excellence.

Results

An ERAS training course must cover the evidence-based principles of ERAS with team-oriented training. Successful implementation requires strong leadership, an ERAS facilitator and an effective MDT. Effectiveness of training can be measured by improved compliance. A training centre of excellence should show a willingness to teach and demonstrable team working.

Conclusions

We propose an international expert consensus providing an ERAS training curriculum, a framework for successful implementation, methods for assessing effectiveness of training and a definition of ERAS training centres of excellence.

Notes

Acknowledgements

The authors are grateful to the experts who contributed to this project.

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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Nader K. Francis
    • 1
    • 2
  • Thomas Walker
    • 1
  • Fiona Carter
    • 3
  • Martin Hübner
    • 4
  • Angela Balfour
    • 5
  • Dorthe Hjort Jakobsen
    • 6
  • Jennie Burch
    • 7
  • Tracy Wasylak
    • 8
    • 9
  • Nicolas Demartines
    • 4
  • Dileep N. Lobo
    • 10
  • Valerie Addor
    • 4
  • Olle Ljungqvist
    • 11
  1. 1.Department of Colorectal SurgeryYeovil District Hospital Foundation TrustSomersetUK
  2. 2.Faculty of ScienceUniversity of BathBathUK
  3. 3.South West Surgical Training Network, ERAS-UKSomersetUK
  4. 4.Department of Visceral SurgeryLausanne University Hospital (CHUV)LausanneSwitzerland
  5. 5.NHS Lothian Western General HospitalEdinburghScotland
  6. 6.Section of Surgical Pathophysiology 4074RigshospitaletCopenhagenDenmark
  7. 7.Head of Gastrointestinal Nurse Education, Academic InstituteSt Mark’s HospitalLondonUK
  8. 8.Strategic Clinical NetworksAlberta Health ServicesEdmontonCanada
  9. 9.Faculty of NursingUniversity of CalgaryCalgaryCanada
  10. 10.Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical CentreNottinghamUK
  11. 11.Department of Surgery, Faculty of Medicine and HealthÖrebro UniversityOrebroSweden

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