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Nutr Diet. 2018 Sep;75(4):345-352. doi: 10.1111/1747-0080.12473. Epub 2018 Sep 5.

Early oral feeding after colorectal surgery: A mixed methods study of knowledge translation.

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Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.
Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
Gold Coast Health, Gold Coast, Queensland, Australia.
Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.



Evidence-based guidelines recommend early oral feeding (EOF) as prescription of an unrestricted diet within 24 hours after colorectal surgery. The present study aimed to understand local postoperative feeding practices after colorectal surgery; identify barriers to EOF implementation; select, tailor and implement stakeholder engagement strategies to facilitate EOF uptake; and evaluate changes to practice.


A longitudinal, mixed methods study was undertaken, guided by the knowledge-to-action framework. Phase 1 assessed the nature of the problem using postoperative diet Audits 1 and 2. In Phase 2, staff interviews identified barriers to EOF implementation. Results from Phases 1 and 2 were fed back to inform Phase 3 strategies. Knowledge uptake was monitored in Audits 3 and 4. Phase 4 evaluated outcomes from Audit 5.


In Phase 1, median time to commencement of full diet was postoperative Days 4 and 3 in Audits 1 and 2, respectively. Phase 2 identified EOF barriers, including disparities in diet upgrade practices and variable understanding of hospital diets. In Phase 3, planned strategies were implemented to improve EOF (i) educational session describing local hospital diets; (ii) consultant decision to prescribe a full diet on operation notes; and (iii) educational sessions with nursing staff describing changes to EOF practice. In Phase 4, median time to commencement of full diet improved to postoperative Day 0. Patients prescribed a full diet on operation notes increased from 0% to 82%.


The present study successfully identified and overcame local barriers to improve EOF practices to align with guideline recommendations.


early oral feeding; enhanced recovery after surgery; postoperative care


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