The Evidence Alone Was Not Enough to Change Practice: A Mixed-methods Analysis Using a Standardized Framework to Understand Perceptions of Barriers and Compliance to ERAS Recommendations.

Purpose: Understanding barriers to compliance can aid in mitigation strategies to address them. This study aims to quantitatively and qualitatively assess the relationship between barriers to ERAS recommendations and perceived ability to assure compliance among multidisciplinary team (MDT) members who deliver Enhanced Recovery After Surgery (ERAS) care.

Design: Embedded mixed-methods survey analysis.

Methods: A survey was distributed to ERAS professionals to assess for each recommendation: how much the recommendation was part of their role; how much they felt they could assure compliance with the recommendation; and the primary barrier to compliance. Imputed datasets were created within each MDT role, significant barriers retained, and prediction models developed. Qualitative data were thematically coded and a mind map visualized themes.

Findings: Most respondents were surgeons with greater than 10 years' experience. Surgeons and advanced practice providers reported highest averages of compliance assurance, nurses the lowest. Barriers most reported were patient factors and lack of agreement. Lack of familiarity and motivation predicted statistically significant decreases in compliance with oral carbohydrate loading. Qualitatively, nurses and surgeons reported lack of agreement from colleagues as the biggest barrier, followed by lack of resources and motivation to change. Other themes were the importance of teamwork, data audit, staff education, and informatics.

Conclusions: Standardized data collection and reporting of barriers to ERAS recommendations may help identify barriers and improve compliance in a multidisciplinary context. A rich, mixed-methods analysis revealed key insights into perceptions of barriers and compliance with ERAS.