Semester of Graduation

May 2020

Degree

Master of Science in Industrial Engineering (MSIE)

Department

Industrial Engineering

Document Type

Thesis

Abstract

Standardization in many industries has proven to lead to improved productivity and efficiency, however, standard practice in healthcare has proven difficult due to patient and physician variation. Evidence-based practices provide an opportunity to create more standardization. Enhanced Recovery After Surgery (ERAS) programs are attempting to standardize the surgical pathways of patients by implementing standard evidence-based steps, beginning in the surgeons office and continuing through a patients discharge (Ljungqvist, Scott, & Fearon, 2017). Implementing ERAS to standardize the surgical care of patients has shown to improve patient outcomes, reduce length of stay and reduce readmissions, however, there is a lack of studies detailing the implementation process to be successful. A literature review by Stone et al. (2018) found only 53 papers on ERAS that discussed implementation. The review organized barriers and facilitators using the Consolidated Framework for Implementation Research (CFIR). The CFIR is a framework organized with five domains and constructs within each domain that could affect implementation (Damschroder et al., 2009). The purpose of this research is to detail implementation and identify barriers and facilitators that impact compliance with an ERAS protocol for colorectal surgery. This research begins by detailing seven steps taken prior to implementing ERAS. Compliance with 19 of the ERAS components will be tracked to measure improvements over the implementation timeline. The first objective is to measure if compliance with the process measures increased from the pre-implementation to post-implementation. The second objective is to measure if implementation leads to a decrease in length of stay. The third objective is to identify barriers and facilitators with implementation by conducting semi structured focus groups with nursing, surgeons, anesthesia and leadership. The outcome of these findings will be an implementation framework. The results of this study showed a significant increase in compliance with 10 of the process measures as well as a significant decrease in length of stay, as measured by a t-test. The semistructured focus groups analyzed by the CFIR indicated that inner setting and implementation plan were the most discussed. Key facilitators to implementation were gaining leadership support and engagement, establishing a multidisciplinary team that meets regularly, and showing process measure and outcome data as feedback. These items are essential to implementation of an ERAS protocol.

Committee Chair

Harvey, Craig

DOI

10.31390/gradschool_theses.5085

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