Stepped implementation of Enhanced Recovery After Surgery in major gynaecological surgery

The Enhanced Recovery After Surgery (ERAS) programme is an evidence-based perioperative management programme that aims at an early recovery after major surgical trauma and consequently at a reduced length of hospitalisation. The ERAS programme proved to be safe and is already standard care in colorectal surgery for many years. This study focuses on large scale implementation of the ERAS programme in major gynaecological surgery in the Netherlands.

To implement the Enhanced Recovery After Surgery (ERAS) programme in elective gynaecological surgery on large scale in an (cost) effective manner is challenging. The traditional used breakthrough method for health care improvement on large scale showed at the best moderately positive effects and requires considerable investments in professional time and energy. The objective of this study is to compare the breakthrough programme with a new stepped approach designed to deliver an optimal effect of implementation efforts at the lowest possible costs.. It is hypothesised that the stepped implementation strategy is more effective compared to the traditional breakthrough methodology for the nationwide uptake of evidence based best practice.

- Retrospective baseline measurement

- Prospective monitoring of patient characteristics, process indicators and outcome measures during the one year implementation period.

- Evaluation of the effectiveness of both strategies every three months after every step or teaching session and at the end of the project. The timing of the teaching sessions of the breakthrough project will be synchronously with the timing of implementation steps.

The intervention group receives an innovative stepped implementation strategy comprising four levels of intensity of support. Implementation starts with generic low-cost activities and builds up to the highest level of tailored and labour-intensive activities. The decision for a stepwise increase in intensive support will be based on the success of implementation so far.



In the control arm hospitals receive the traditional breakthrough strategy with educational sessions and the use of plan-do-study-act cycles for planning and executing local improvement activities.