Implementation science approaches to enhance uptake of complex interventions in surgical settings
Angela Byrnes
A B G , Alison Mudge C D E and David Clark E F
+ Author Affiliations
- Author Affiliations
A School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Qld 4067, Australia.
B Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Herston, Qld 4029, Australia.
C Internal Medicine and Aged Care, Royal Brisbane and Women’s Hospital, Herston, Qld 4029, Australia.
D Institute for Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld 4006, Australia.
E Faculty of Medicine, The University of Queensland, St Lucia, Qld 4067, Australia.
F Surgical and Perioperative Services, Royal Brisbane and Women’s Hospital, Herston, Qld 4029, Australia.
G Corresponding author. Email: a.byrnes@uq.edu.au
Australian Health Review 44(2) 310-312 https://doi.org/10.1071/AH18193
Submitted: 20 September 2018 Accepted: 7 January 2019 Published: 15 April 2019
Abstract
Achieving practice change in the complex healthcare environment is difficult. Effective surgical care requires coordination of services across the continuum of care, involving interdisciplinary collaboration across multiple units, with systems and processes that may not connect effectively. Principles of enhanced recovery after surgery (ERAS) are increasingly being incorporated into facility policies and practice, but the literature reports challenges with both initial adherence and mid- to long-term sustainability. Greatest adherence is typically observed for the intraoperative elements, which are within the control of a single discipline, with poorest adherence reported for postoperative processes occurring in the complex ward environment. Using ERAS as an example, this perspective piece describes the challenges associated with implementation of complex interventions in the surgical setting, highlighting the value that implementation science approaches can bring to practice change initiatives and providing recommendations as to suggested course of action for effective implementation.
Additional keywords: enhanced recovery after surgery, perioperative care, evidence-based practice, implementation science, multidisciplinary communication.
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