Introduction
In the push to elevate the standards of hospital patient care, the adoption of care bundles—concise sets of evidence-based practices—has emerged as a cornerstone strategy. However, the journey from blueprint to bedside is layered with challenges that impact their roll-out and effectiveness. A comprehensive scoping review has surfaced insights into these barriers and the facilitators that could herald successful outcomes in the use of care bundles across acute care settings.
Background
Care bundles, groupings of best practices that have been scientifically validated, aim to improve patient outcomes by enhancing the consistency of care delivery. Despite their potential, variability in design and implementation can dull their effectiveness, causing discrepancies in the results achieved across hospital settings.
The Study
The study, registered with PROSPERO (CRD 42015029963) and published in Implementation Science, examined the makeup, application, and evaluation of care bundles in hospital settings. This scoping review wielded the framework established by Arksey and O’Malley, surveying literature from databases including Embase, CINAHL, and Cochrane, as well as Ovid MEDLINE, from 2001 through November 2017.
The Downs and Black checklist was initially used to assess the articles’ quality. Subsequently, strategies for implementation were benchmarked against the Expert Recommendations for Implementing Change (ERIC) criteria. In total, 28,692 publications were scanned, resulting in the extraction of data from 99 quantitative studies.
Discovery of Challenges and Enablers
Although the study revealed a promising landscape for care bundles, it also highlighted a significant barrier: the complexity of a care bundle was inversely related to compliance rates. Bundles with fewer, simpler elements saw better adherence. The structured reporting of strategies appeared inadequate, with a lack of reporting structure and with 23% of the studies scoring low on the Downs and Black checklist.
Still, strategies associated with successful care bundle implementation were uncovered. These included iterative approaches, cultivating relationships with stakeholders, and prioritizing education and training.
Key Recommendations and Considerations
1. Simplifying care bundles to a minimal number of elements could improve adherence.
2. Customizing care bundles to the context of the healthcare setting, including stakeholder involvement, can enhance compliance.
3. Employing iterative evaluation approaches ensures care bundles are continually refined for maximum efficacy.
4. Standardized reporting of implementation strategies is pivotal for comparing results and sharing successful practices across healthcare systems.
Implications for Healthcare Systems
The findings from this review suggest that by streamlining care bundles and focusing on structured implementation plans, healthcare institutions might foster higher compliance and better patient outcomes. Adjusting intricate processes to more manageable, clearly defined actions facilitates both the adoption of care bundles by healthcare providers and their sustained use over time.
Future Research and Practice
Further research may delve into the development of universal reporting standards for care bundle strategies, enabling healthcare systems to share and leverage collective experience and data. Additionally, exploring how care bundles may be adapted for broader applications—across diverse healthcare settings and varying patient groups—could form the backbone of future studies.
Conclusion
The review elucidates the roadblocks and conduits to successful care bundle implementation in acute hospital care. With clear evidence that simplicity and structured strategies are key, healthcare providers and decision-makers are called to cut through complexity and adopt a methodical, evidence-informed approach to elevate patient care standards.
Keywords
1. Care Bundles Implementation
2. Evidence-Based Clinical Practice
3. Hospital Acute Care
4. Implementation Strategies Healthcare
5. Patient Care Quality Improvement
References
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3. Resar, R., Griffin, F. A., Haraden, C., & Nolan, T. W. (2012). Using Care Bundles to Improve Health Care Quality. IHI Innovation Series white paper. Cambridge: Institute for Healthcare Improvement. (Available on www.IHI.org).
4. Schweizer, M., Perencevich, E., McDanel, J., Carson, J., Formanek, M., Hafner, J., Braun, B., & Herwaldt, L. (2013). Effectiveness of a bundled intervention of decolonization and prophylaxis to decrease Gram positive surgical site infections after cardiac or orthopedic surgery: systematic review and meta-analysis. BMJ, 346(jun13 1), f2743. https://doi.org/10.1136/bmj.f2743
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