Toward a Learning System for ERAS: Embedding Implementation and Learning Evaluation

The idea of implementing specific interventions throughout the perioperative period to improve patient recovery has been proven to be beneficial. Whereas many approaches to enhanced recovery after surgery (ERAS) implementation may seem straightforward, careful advanced planning, multiple stakeholder involvement, and addressing other contextual constraints needed for program scale-up and sustainability are complex. The lack of clarity and descriptions of the implementation strategies, report on implementation variables, and the context under which the implementation occurs hinders learning and spread. Without the detailed context in which it was implemented, one is often led to disappointment or outright failure of spread and scale-up efforts. This chapter provides a framework and guidance on how clinicians and health-care leaders can work together to design, implement, and learn about ERAS improvement interventions more effectively, thus enhancing the scale-up, spread and return on investment in ERAS.