ORIGINAL SCIENTIFIC REPORT
Consensus on Training and Implementation of Enhanced
Recovery After Surgery: A Delphi Study
Nader K. Francis
Dorthe Hjort Jakobsen
Dileep N. Lobo
Published online: 4 January 2018
Internationale de Chirurgie 2018
Background Enhanced Recovery After Surgery (ERAS) is widely accepted in current surgical practice due to its
positive impact on patient outcomes. The successful implementation of ERAS is challenging and compliance with
protocols varies widely. Continual staff education is essential for successful ERAS programmes. Teaching modalities
exist, but there remains no agreement regarding the optimal training curriculum or how its effectiveness is assessed.
We aimed to draw consensus from an expert panel regarding the successful training and implementation of ERAS.
Methods A modiﬁed Delphi technique was used; three rounds of questionnaires were sent to 58 selected international
experts from 11 countries across multiple ERAS specialities and multidisciplinary teams (MDT) between January
2016 and February 2017. We interrogated opinion regarding four topics: (1) the components of a training curriculum
and the structure of training courses; (2) the optimal framework for successful implementation and audit of ERAS
including a guide for data collection; (3) a framework to assess the effectiveness of training; (4) criteria to deﬁne
ERAS training centres of excellence.
Results An ERAS training course must cover the evidence-based principles of ERAS with team-oriented training.
Successful implementation requires strong leadership, an ERAS facilitator and an effective MDT. Effectiveness of
training can be measured by improved compliance. A training centre of excellence should show a willingness to teach
and demonstrable team working.
Conclusions We propose an international expert consensus providing an ERAS training curriculum, a framework for
successful implementation, methods for assessing effectiveness of training and a deﬁnition of ERAS training centres
The data in this paper have, in part, been presented at the following
meeting: The international ERAS Conference: Lyon May 2017.
& Nader K. Francis
Department of Colorectal Surgery, Yeovil District Hospital
Foundation Trust, Higher Kingston, Yeovil,
Somerset BA21 4AT, UK
Faculty of Science, University of Bath, Wessex House 3.22,
Bath BA2 7AY, UK
South West Surgical Training Network, ERAS-UK, Yeovil,
Somerset BA20 2RH, UK
Department of Visceral Surgery, Lausanne University
Hospital (CHUV), Rue de Bugnon 46, 1011 Lausanne,
NHS Lothian Western General Hospital, Crewe Road,
Edinburgh EH4 2XU, Scotland
Section of Surgical Pathophysiology 4074, Rigshospitalet,
Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
Head of Gastrointestinal Nurse Education, Academic
Institute, St Mark’s Hospital, London HA1 3UJ, UK
World J Surg (2018) 42:1919–1928