Optimizing Implementation of the Neonatal Enhanced Recovery After Surgery Guideline

Brandon Pentz; Palak Patel; Mercedes Pilkington; Oluwatomilayo Daodu; Jennifer Y K Lam; Alexandra Howlett; Lori Stephen; Adam Spencer; Jennifer Unrau; Michelle Theam; Mary E Brindle

doi:10.1016/j.jpedsurg.2024.06.021

Optimizing Implementation of the Neonatal Enhanced Recovery After Surgery Guideline

J Pediatr Surg. 2024 Jul 6:S0022-3468(24)00406-8. doi: 10.1016/j.jpedsurg.2024.06.021. Online ahead of print.

Authors

Affiliations

¹ Department of Surgery, University of Calgary, Calgary, AB, Canada. Electronic address: Brandon.Pentz@ucalgary.ca.
² Department of Surgery, University of Calgary, Calgary, AB, Canada.
³ Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
⁴ Department of Surgery, University of Calgary, Calgary, AB, Canada; Department of Pediatric Surgery, Alberta Children's Hospital, Calgary, AB, Canada.
⁵ Division of Pediatric Surgery, Children's Hospital at London Health Sciences Centre, London, ON, Canada.
⁶ Department of Neonatology, Alberta Children's Hospital, Calgary, AB, Canada.
⁷ Department of Anesthesia, Alberta Children's Hospital, Calgary, AB, Canada.

PMID: 39068053
DOI: 10.1016/j.jpedsurg.2024.06.021

Abstract

Introduction: Enhanced Recovery After Surgery (ERAS®) protocols require multidisciplinary team engagement from healthcare professionals (HCPs), where limited studies exist on neonatal ERAS®protocols. Therefore, we aimed to capture perceptions of HCPs on facilitation and implementation of the neonatal ERAS®guideline.

Methods: 10 neonates were recruited. 13 HCPs involved in these patient's care were interviewed and 8 surveyed consisting of pediatric anesthesiologists, neonatologists, neonatal intensive care unit (NICU) registered nurses (RNs), and pediatric surgeons. Using a multi-methods design, recruitment, semi-structured interviews and surveys were conducted from May 17, 2021 to November 1, 2022. Data was coded using The Promoting Action on Research Implementation in Health Studies and then thematically analyzed.

Results: Interviews were conducted with 4 pediatric anesthesiologists, 4 neonatologists, 2 NICU RNs, and 3 pediatric surgeons and surveys with 1 pediatric anesthesiologist, 2 neonatologists, 3 NICU RNs, and 2 pediatric surgeons. From interviews, the top 3 facilitation strategies were utilization of: (1) multidisciplinary guideline champions, (2) reminders and education, and (3) results to facilitate adherence. Incorporation of these strategies resulted in perceived: (1) stronger buy-in and engagement and (2) improved team communication, job satisfaction, care quality, and parental involvement.

Conclusion: HCPs stressed the importance of guideline champions, reminders and education, and results distribution. Given implementation during the COVID-19 pandemic, awareness and education were mixed. Nonetheless, HCPs perceived improved buy-in and engagement, communication, job satisfaction, quality of care, and parental involvement. Incorporation of these strategies can promote successful ERAS® guideline facilitation and implementation and should be considered for future ERAS® projects.

Level of evidence: IV.

Keywords: ERAS®; Enhanced recovery after surgery; Facilitation; Implementation; Neonatal.