ArticleBMJ open2019
Enhanced Recovery After Surgery implementation in practice: an ethnographic study of services for hip and knee replacement.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
What it found
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Content and delivery of pre-operative interventions for patients undergoing total knee replacement: a rapid review.Systematic reviews · 2022Pooled it
- National survey of protocols for day-case hip and knee arthroplasty in the UK.Bone & joint open · 2026Article
- Enhanced recovery following neck of femur fractures - improving outcomes : a survey of current perioperative practice.Bone & joint open · 2025Article
- The factors determining early mobilization in elderly patients undergoing total knee replacement.BMC geriatrics · 2025Article
- Implementation of an Integrated Pediatric Perioperative Pain Pathway: A Quality Improvement Initiative.Anesthesiology research and practice · 2025Article
- Can Patient-Reported Outcomes Measurement Information System estimate high-impact chronic pain after total shoulder arthroplasty?JSES international · 2024Article
- Resistance exercise training to improve post-operative rehabilitation in knee arthroplasty patients: A narrative review.European journal of sport science · 2024Review
- The role of enhanced recovery after surgery (ERAS) in promoting quality improvement and patient safety in pediatric urology.Frontiers in urology · 2023Review
- Enhanced recovery after surgery for major orthopedic surgery: a narrative review.Knee surgery & related research · 2022Review
- Differences in preoperative function and outcome of patients with versus without sarcopenia after total hip arthroplasty.Journal of physical therapy science · 2022Article
- Consensus on pre-operative total knee replacement education and prehabilitation recommendations: a UK-based modified Delphi study.BMC musculoskeletal disorders · 2021Article
- Review
- The maximal gait speed is a simple and useful prognostic indicator for functional recovery after total hip arthroplasty.BMC musculoskeletal disorders · 2020Article
- Article
- A scoping review of the use of ethnographic approaches in implementation research and recommendations for reporting.Implementation research and practiceArticle
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
objectivesEnhanced Recovery After Surgery (ERAS) programmes aim to improve care quality by optimising components of the care pathway and programmes for hip and knee replacement exist across the UK. However, there is variation in delivery and outcomes. This study aims to understand processes that influence implementation using the Consolidated Framework for Implementation Research (CFIR) to inform the design and delivery of services.
designAn ethnographic study using observations and interviews with staff involved in service delivery. Data were analysed using a thematic analysis, followed by an abductive approach whereby themes were mapped onto the 31 constructs and 5 domains of the CFIR.
settingFour hospital sites in the UK delivering ERAS services for hip and knee replacement.
participants38 staff participated including orthopaedic surgeons, nurses and physiotherapists.
resultsResults showed 17 CFIR constructs influenced implementation in all five domains. Within 'intervention characteristics', participants thought ERAS afforded advantages over alternative solutions and guidance was adaptable. In the 'outer setting', it was felt ERAS should be tailored to patients and education used to empower them in their recovery. However, there were concerns about postdischarge support and tensions with primary care. Within the 'inner setting', effective multidisciplinary collaboration was achieved by transferring knowledge about patients along the care pathway and multidisciplinary working practices. ERAS was viewed as a 'message' that had to be communicated consistently. There were concerns about resources and high volumes of patients. Staff access to information varied. At the domain 'characteristics of individuals', knowledge and beliefs impacted on implementation. Within 'process', involving opinion leaders in development and 'champions' who acted as a central point of contact, helped to engage staff. Formal and informal feedback helped to develop services.
conclusionsFindings demonstrate successful implementation involves empowering patients to work towards recovery, providing postdischarge support and promoting successful multidisciplinary team working.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.