Abstract
Abstract
Background
Enhanced Recovery After Surgery (ERAS) is a multidisciplinary care model that requires sustained coordination across perioperative teams. Although ERAS has been widely evaluated in terms of clinical outcomes, less is known about how its transition from voluntary participation to standardized institutional practice is associated with patient safety culture over time. This study examined longitudinal changes in patient safety culture during five years of ERAS implementation and institutionalization in multidisciplinary colorectal surgical teams.
Methods
This retrospective longitudinal program evaluation used de-identified, aggregated unit-level results from the Taiwan Patient Safety Culture Survey collected annually from 2019 to 2023 at a medical center in Taiwan. The dataset contained respondent numbers and positive response rates for Teamwork Climate, Job Satisfaction, Working Conditions, and Resilience for each available unit-year across multidisciplinary perioperative teams (Anesthesiology, Operating Room, Surgical Ward, Physiotherapy, and Nutrition). Analyses were descriptive because individual responses and item-level positive-response counts were unavailable; percentages were not converted into estimated counts and no inferential tests were performed.
Results
Longitudinal patterns varied across units, domains, and years. In Anesthesiology, Resilience changed from 11.9% in 2019 to 41.2% in 2023 and Working Conditions from 59.3% to 84.0%. Operating Room Working Conditions changed from 30.4% to 39.7%. Surgical Ward Resilience changed from 4.6% to 8.3%, with a temporary peak of 58.6% in 2022. Nutrition Teamwork Climate changed from 60.4% to 89.2%. Physiotherapy Teamwork Climate was 100.0%, 100.0%, 91.7%, 75.9%, and 98.2% from 2019 through 2023, respectively. Complete four-domain trajectories for all multidisciplinary units are reported in Table 1.
Conclusions
ERAS institutionalization was accompanied by heterogeneous changes in patient safety culture across multidisciplinary colorectal surgical units. Higher 2023 values in several unit-domain measures coexisted with substantial year-to-year fluctuation and declines in others. These findings describe organizational trends and do not establish individual change, statistical significance, or causal effects of ERAS. Prospective multicenter studies with individual-level and implementation data are needed.
Trial Registration:
Not applicable.