title: A qualitative study to understand the barriers and enablers in implementing an enhanced recovery after surgery program.
abstract: OBJECTIVE
  Explore the barriers and enablers to adoption of an Enhanced Recovery after Surgery (ERAS) program by the multidisciplinary perioperative team responsible for the care of elective colorectal surgical patients.
  
  
  BACKGROUND
  ERAS programs include perioperative interventions that when used together have led to decreased length of stay while increasing patient recovery and satisfaction. Despite the known benefits of ERAS programs, uptake remains slow.
  
  
  METHODS
  Semistructured interviews were conducted with general surgeons, anesthesiologists, and ward nurses at 7 University of Toronto-affiliated hospitals to identify potential barriers and enablers to adoption of 18 ERAS interventions. Grounded theory was used to thematically analyze the transcribed interviews.
  
  
  RESULTS
  Nineteen general surgeons, 18 anesthesiologists, and 18 nurses participated. The mean time of each interview was 18 minutes. Lack of manpower, poor communication and collaboration, resistance to change, and patient factors were cited by most as barriers. Discipline-specific issues were identified although most related to resistance to change. Overall, interviewees were supportive of implementation of a standardized ERAS program and agreed that a standardized guideline based on best evidence; standardized order sets; and education of the staff, patients, and families are essential.
  
  
  CONCLUSIONS
  Multidisciplinary perioperative staff supported the implementation of an ERAS program at the University of Toronto-affiliated hospitals. However, major barriers were identified, including the need for patient education, increased communication and collaboration, and better evidence for ERAS interventions. Identifying these barriers and enablers is the first step toward successfully implementing an ERAS program.
authors.affiliation: *Zane Cohen Clinical Research Centre †Samuel Lunenfeld Research Institute, and ‡Department of Surgery, Mount Sinai Hospital §Department of Surgery, Toronto East General Hospital ¶Division of General Surgery, University Health Network **Departments of Surgery ††Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Pearsall
authors.forename: Zahida
authors.initials: Z
authors.lastname: Meghji
authors.forename: Kristen B
authors.initials: KB
authors.lastname: Pitzul
authors.forename: Mary-Anne
authors.initials: MA
authors.lastname: Aarts
authors.forename: Marg
authors.initials: M
authors.lastname: McKenzie
authors.forename: Robin S
authors.initials: RS
authors.lastname: McLeod
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
mesh_terms: D001291:Attitude of Health Personnel; D002170:Canada; D003106:Colon / Q000601:surgery; D003142:Communication; D017558:Elective Surgical Procedures / Q000592:standards*; D019983:Guideline Adherence; D006785:Hospitals, University / Q000592:standards*; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D010353:Patient Education as Topic; D019990:Perioperative Care / Q000592:standards*; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D012007:Rectum / Q000601:surgery