Requirements for a successful Enhanced Recovery After Surgery (ERAS) program - A multicenter international survey among ERAS nurses.

INTRODUCTION Nurses are the linchpin of Enhanced Recovery After Surgery (ERAS) program, as they are in direct contact with patients and various caregivers. The aim of the present survey was to assess ERAS key factors and challenges from a nurse perspective. METHODS Qualitative study among ERAS dedicated nurses and ERAS Interactive Audit System (EIAS) administrators using an online questionnaire (Survey Monkey®) yielding 29 questions. The survey focused on challenges and drawbacks encountered during ERAS training, implementation and daily clinical practice. Closed multiple choice- and open-end questions and semantic differential scales (0-10) were used. Panelists received 3 reminders within 4 and 8 weeks after invitation. RESULTS 123 out of 306 invited nurses completed the sur¬vey (response rate 40%). Overall, the success of the institutional ERAS program was rated a 6.9±2/10. Improving both patient outcomes (90%) and satisfaction (69%) were rated as main motivators for ERAS implementation, while time restraints (50%) and logistics (43%) were identified as main barriers. The study revealed a wide heterogeneity in coordination and management strategies (ERAS meetings, work models, teaching strategies). Sustained staff education before (9.1/10 ) and after (9.1/10) implementation, a dedicated ERAS coordinator (8.9/10) and regular meetings (8.3/10 scale) were rated as key factors for a successful program. Difficulty of implementation, maintenance and data acquisition were all rated >5/10. CONCLUSION Despite heterogeneity in coordination and management, ERAS program is evaluated assuccessfully from a nurse perspective. Continuous staff education and coordination beyond the implementation period appear to be of utmost importance for a sustained program.