Phase-based Governance-Driven GO-ERAS Implementation: A Two-Center Pilot Path to Scalable Gynecologic-Oncology ERAS Adoption

General
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Phase-based Governance-driven GO-ERAS Implementation: A Two-Center Pilot Path to Scalable Adoption

Executive summary: Suboptimal GO-ERAS adherence across institutions hinders consistent improvement in perioperative outcomes. A governance-led, phase-based implementation blueprint—featuring a standardized GO-ERAS bundle, dedicated champions, and real-time audit/feedback—offers a practical pathway from guideline to practice. A two-center before-after pilot can illuminate barriers, test feasibility, and refine processes before broader rollout.

Context and problem statement

  • GO-ERAS guidelines exist, but implementation in real-world perioperative pathways is uneven across hospitals.
  • Barriers include governance fragmentation, resource variability, data-tracking limitations, and misalignment with local workflows.
  • A governance-driven, phased approach aligns guideline translation with organizational priorities and continuous improvement culture.

The proposed solution: Phase-based governance-driven GO-ERAS package

  • Phase 1 – Governance, barrier assessment, and alignment: Establish a multidisciplinary GO-ERAS Implementation Steering Committee; map local barriers and assets; define hospital-level targets and a concise go-live subset of ERAS items.
  • Phase 2 – Pathway selection and customization: Adopt a GO-specific ERAS bundle with preop, intraop, and postop components; create standardized order sets, checklists, and patient education materials tailored to local feasibility.
  • Phase 3 – Education, training, and culture change: Develop targeted curricula; identify and empower GO-ERAS champions; conduct kickoff workshops and refreshers.
  • Phase 4 – Data, IT, and measurement infrastructure: Embed GO-ERAS order sets/checklists in the EHR with reminders; establish an adherence scoring system and monthly dashboards at center and coordinating-center levels.
  • Phase 5 – Pilot implementation and iterative improvement: Deploy in two centers using a before-after design; run 12–18 months of GO-ERAS; implement Plan-Do-Study-Act (PDSA) cycles with structured audits.
  • Phase 6 – Evaluation, optimization, and scaling: Perform multi-center before-after analyses adjusted for case mix; refine items with limited impact; develop scalable expansion plan and funding model.
  • Phase 7 – Sustainability and continuous improvement: Annual reviews, integration with accreditation, ongoing training, and dissemination of best practices.

Implementation details: artifacts, governance, and metrics

  • Governance: GO-ERAS charter, steering committee roles, and site-specific implementation plans.
  • Pathway artifacts: GO-ERAS bundle document, standardized order sets, checklists, and patient education toolkit.
  • Education: curricula, GO-ERAS champions network, and training completion records.
  • Data and measurement: EHR-integrated order sets, adherence scoring, and monthly dashboards; data governance and privacy plan.
  • Pilot metrics: GO-ERAS adherence score, completeness of documentation, LOS, perioperative complications, and readmissions; number and impact of PDSA cycles.

Pilot design and evaluation framework

  • Design: Two-center before-after pilot to assess feasibility, barriers, and initial impact on adherence and perioperative outcomes.
  • Duration: 12–18 months of GO-ERAS implementation with iterative PDSA cycles.
  • Primary goals: Improve adherence signals and identify actionable barriers; refine the GO-ERAS bundle for scalability.
  • Evaluation considerations: Data governance, case-mix adjustment, and acknowledgment of the limitations of before-after designs.

Resource and economic considerations

  • Recognize that staffing, IT readiness, and baseline performance vary widely; costs will be context-specific.
  • IT investments (order sets, dashboards) are central to enabling real-time adherence feedback.
  • Include sensitivity analyses during scaling to account for local resource constraints and fidelity maintenance.

Patient-centered outcomes and engagement

  • Integrate patient education as a core component of the GO bundle.
  • Measure patient satisfaction and perioperative experience to ensure pathway changes reflect patient priorities.
  • Align pathway goals with patient-valued outcomes to maximize acceptance and value.

Risks, ethics, and compliance

  • Label outputs with knowns vs uncertainties; avoid overclaiming results.
  • Ensure privacy and data governance; obtain IRB oversight as required for activities extending beyond standard quality improvement.
  • Address cross-site data-sharing safeguards and de-identification practices.

Scaling, sustainability, and next steps

  • Define explicit criteria for expanding to additional centers (performance thresholds, governance capacity, funding availability).
  • Develop a sustainability plan that includes ongoing training, governance funding, and alignment with accreditation programs.
  • Encourage collaboration and data-sharing within a governance framework that protects patient privacy.

Appendices and practical tools (optional)

  • Templates: GO-ERAS governance charter; GO-ERAS bundle; data dictionaries; pilot data collection templates.
  • Mock dashboards: Example GO-ERAS adherence dashboards for centers and coordinating centers.
  • Educational materials: Standardized staff training modules and patient education handouts.

Knowns and uncertainties

  • Knowns: There is a reproducible structure for governance-led, phase-based implementation; a standardized GO-ERAS bundle is foundational for fidelity; real-time adherence tracking via EHR is essential for continuous improvement; two-center pilots can illuminate barriers and inform refinement; economic analyses are necessary for sustainable scale-up; patient-centered outcomes should be integrated into evaluation.
  • Uncertainties: Which GO-ERAS components yield the greatest impact across diverse centers; the optimal governance model and champion density; exact cost ranges and resource implications; tailoring strategies for resource-limited centers; long-term sustainability dynamics and impact on adherence stability.

References (actionable, PMIDs available when possible)

  • ERAS guidelines for gynecologic oncology (GO-ERAS). Note: PMIDs to be appended when available from GO-ERAS publications.
  • General implementation science frameworks (e.g., CFIR) to guide governance and audit/feedback strategies. PMIDs to be appended when available.
  • Additional GO-ERAS pathway and implementation studies as they become available; include PMIDs where published.

Next steps for readers

  • Consider piloting a phase-based GO-ERAS implementation in two centers within your system.
  • Form a multidisciplinary GO-ERAS steering group and appoint dedicated champions to begin Phase 1 activities (governance, barrier assessment, alignment).
  • Review the GO-ERAS bundle and order sets; provide feedback on feasibility across diverse settings.
  • Plan to share pilot data (adherence signals, barriers, early outcomes) to inform iterative refinements and scalable rollout plans.
  • Engage with a collaborative for standardized metrics, dashboards, and data-sharing approaches that enable cross-site learning.

Note: Outputs intentionally label knowns vs uncertainties, and avoid universal claims about effect sizes or cost savings prior to pilot data. Ethical and regulatory considerations should guide expansion beyond standard quality improvement.