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

Francis, Nader K; Walker, Thomas; Carter, Fiona; H�bner, Martin; Balfour, Angela; Jakobsen, Dorthe Hjort; Burch, Jennie; Wasylak, Tracy; Demartines, Nicolas; Lobo, Dileep N.; Addor, Valerie; Ljungqvist, Olle

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 chal-lenging 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 select-ed international experts from 11 countries across multiple ERAS specialities and multidisci-plinary teams (MDT) between January 2016 and February 2017.
We interrogated opinion regarding 4 topics: (i) the components of a training curriculum and the structure of training courses; (ii) the optimal framework for successful implementation and audit of ERAS including a guide for data collection; (iii) a framework to assess the effective-ness of training; (iv) criteria to define ERAS training centres of excellence.

Results
An ERAS training course must cover the evidence-based principles of ERAS with team ori-enated training. Successful implementation requires strong leadership, an ERAS facilitator as well as an effective MDT. Effectiveness of training can be measured by improved compli-ance. 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.

Citation

Francis, N. K., Walker, T., Carter, F., Hübner, M., Balfour, A., Jakobsen, D. H., Burch, J., Wasylak, T., Demartines, N., Lobo, D. N., Addor, V., & Ljungqvist, O. (2018). Consensus on Training and Implementation of Enhanced Recovery After Surgery: A Delphi Study. World Journal of Surgery, 42(7), 1919–1928. https://doi.org/10.1007/s00268-017-4436-2

• Journal Article Type: Article
• Acceptance Date: Dec 4, 2017
• Online Publication Date: Jan 4, 2018
• Publication Date: 2018-07
• Deposit Date: Dec 13, 2018
• Publicly Available Date: Jan 5, 2019
• Journal: World Journal of Surgery
• Print ISSN: 0364-2313
• Electronic ISSN: 1432-2323
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 42
• Issue: 7
• Pages: 1919–1928
• DOI: https://doi.org/10.1007/s00268-017-4436-2
• Public URL: https://nottingham-repository.worktribe.com/output/1410571
• Publisher URL: https://link.springer.com/article/10.1007%2Fs00268-017-4436-2
• Additional Information: This is a post-peer-review, pre-copyedit version of an article published in World Journal of Surgery. The final authenticated version is available online at: http://dx.doi.org/10.1007/s00268-017-4436-2.
• Contract Date: Dec 13, 2018