Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
, 14 (1), 47

Barriers and Facilitators to the Successful Development, Implementation and Evaluation of Care Bundles in Acute Care in Hospital: A Scoping Review

Affiliations
Review

Barriers and Facilitators to the Successful Development, Implementation and Evaluation of Care Bundles in Acute Care in Hospital: A Scoping Review

D Gilhooly et al. Implement Sci.

Abstract

Background: Care bundles are small sets of evidence-based recommendations, designed to support the implementation of evidence-based best clinical practice. However, there is variation in the design and implementation of care bundles, which may impact on the fidelity of delivery and subsequently their clinical effectiveness.

Methods: A scoping review was carried out using the Arksey and O'Malley framework to identify the literature reporting on the design, implementation and evaluation of care bundles. The Embase, CINAHL, Cochrane and Ovid MEDLINE databases were searched for manuscripts published between 2001 and November 2017; hand-searching of references and citations was also undertaken. Data were initially assessed using a quality assessment tool, the Downs and Black checklist, prior to further analysis and narrative synthesis. Implementation strategies were classified using the Expert Recommendations for Implementing Change (ERIC) criteria.

Results: Twenty-eight thousand six hundred ninety-two publications were screened and 348 articles retrieved in full text. Ninety-nine peer-reviewed quantitative publications were included for data extraction. These consisted of one randomised crossover trial, one randomised cluster trial, one case-control study, 20 prospective cohort studies and 76 non-parallel cohort studies. Twenty-three percent of studies were classified as poor based on Downs and Black checklist, and reporting of implementation strategies lacked structure. Negative associations were found between the number of elements in a bundle and compliance (Spearman's rho = - 0.47, non-parallel cohort and - 0.65, prospective cohort studies), and between the complexity of elements and compliance (p < 0.001, chi-squared = 23.05). Implementation strategies associated with improved compliance included evaluative and iterative approaches, development of stakeholder relationships and education and training strategies.

Conclusion: Care bundles with a small number of simple elements have better compliance rates. Standardised reporting of implementation strategies may help to implement care bundles into clinical practice with high fidelity.

Trial registration: This review was registered on the PROSPERO database: CRD 42015029963 in December 2015.

Keywords: Care bundles; Evaluation; Evidence-based care; Healthcare improvement; Implementation; Improvement science; Intervention design; Quality improvement.

Conflict of interest statement

Ethics approval and consent to participate

Not applicable

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of scoping review
Fig. 2
Fig. 2
Frequency of element number in the included care bundles. x-axis—number of elements in a bundle. y-axis—frequency
Fig. 3
Fig. 3
Frequency of element complexity per compliance range. x-axis—compliance range. y-axis—frequency. Simple. Complex

Similar articles

See all similar articles

References

    1. Sackett DL. Evidence-Based Medicine: How to Practice and Teach EBM. New York: Churchill Livingstone; 1997.
    1. Allen D, Harkins KJ. Too much guidance? Lancet. 2017;365(9473):1768. doi: 10.1016/S0140-6736(05)66578-6. - DOI - PubMed
    1. Resar R, Gri n FA, Haraden C, Nolan TW. Using Care Bundles to Improve Health Care Quality. IHI Innovation Series white paper. Cambridge: Institute for Healthcare Improvement; 2012. (Available onwww.IHI.org).
    1. Ospina MB, Mrklas K. Deuchar L, et al. A systematic review of the effectiveness of discharge care bundles for patients with COPD Thorax. 2017;72:31–9. - PubMed
    1. Ma N, Cameron A, Tivey D, Grae N, Roberts S, Morris A. Systematic review of a patient care bundle in reducing staphylococcal infections in cardiac and orthopaedic surgery. ANZ J Surg Australia. 2017;87(4):239–246. doi: 10.1111/ans.13879. - DOI - PubMed

Publication types

Feedback