Implementing enhanced recovery pathways: a literature review with realist synthesis

Coxon, Astrid, Nielsen, Karina, Cross, Jane ORCID: and Fox, Chris ORCID: (2017) Implementing enhanced recovery pathways: a literature review with realist synthesis. Hospital Practice, 45 (4). pp. 165-174. ISSN 2377-1003

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Objectives: Enhanced Recovery Pathways (ERPs) are an increasingly popular, evidenced-based approach to surgery, designed to improve patient outcomes and reduce costs. Despite evidence demonstrating the benefits of these pathways, implementation and adherence have been inconsistent. Methods: Using realist synthesis, this review explored the current literature surrounding the implementation of ERPs in the UK. Knowledge consolidation between authors and consulting with field experts helped to guide the search strategy. Relevant medical and social science databases were searched from 2000 to 2016, as well as a general web search. A total of 17 papers were identified, including original research, reviews, case studies and guideline documents. Full texts were analysed, cross-examined, and data extracted and synthesised. Results: Several implementation strategies were identified, including the contexts in which these operated, the subsequent mechanisms of action that were triggered, and the outcome patterns they produced. Context-Mechanism-Outcome (CMO) configurations were generated, tested, and refined. These were grouped to develop two programme theories concerning ERP implementation, one related to the strategy of consulting with staff, the other with appointing a change agent to coordinate and drive the implementation process. These theories highlight instances in which implementation could be improved. Conclusion: Current literature in ERP research is primarily focussed on measuring patient outcomes and cost effectiveness, and as a result, important detail regarding the implementation process is often not reported or described robustly. This review not only provides recommendations for future improvements in ERP implementation, but also highlights specific areas of focus for furthering ERP implementation research.

Item Type: Article
Uncontrolled Keywords: enhanced recovery,implementation,realist synthesis,change agency,cmo configuration,context-mechanism-outcome
Faculty \ School: Faculty of Social Sciences > School of Psychology
Faculty of Medicine and Health Sciences > Norwich Medical School
Faculty of Medicine and Health Sciences > School of Health Sciences
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Depositing User: Pure Connector
Date Deposited: 25 Jul 2017 05:09
Last Modified: 13 May 2023 00:11
DOI: 10.1080/21548331.2017.1351858

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