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Table 1 Overview of implementation initiatives selected as case studies

From: Identification of factors that support successful implementation of care bundles in the acute medical setting: a qualitative study

 

COPD Bundle—A1

Diabetic Foot—B1

Duration

04/09- 09/10

04/11- 09/12

Site

Hospital A

Hospital B

Implementation team

Respiratory consultants, clinical nurse specialists, pharmacist, patient advisor, physiotherapist, smoking cessation specialist, project manager (nurse) and QI advisors

Endocrinology consultants, patient advisors, podiatrist ward/specialist nurses, project manager (nurse), research nurse and QI advisorsa

Resources for implementation

£100,000

£100,000

Evidence-base for bundle

National Institute for Health and Clinical Excellence Clinical guideline 101 (2010) [14]

Diabetes UK Guidelines (2011) and National Institute for Health and Clinical Excellence Clinical guideline 119 (2011) [15, 16]

Defined patient group/segment

Patients admitted to hospital due to an acute exacerbation of COPD

Patients admitted to hospital for any reason with known diabetes

Care setting

Acute medical unit/ward

Acute medical unit/ward

Time to deliver bundle

During admission

During admission

Outcomes to be improved

Reduced readmission to hospital and in hospital mortality

Reduced readmission to hospital and complication of diabetic foot including amputation

Care bundle elements

COPD Bundle for acute exacerbation

• Respiratory nurse notified of admission

• Smokers offered smoking cessation assistance

• Referral to pulmonary rehabilitation for assessment

• Provision of written information about COPD

• Assessment and demonstration of satisfactory inhaler use

• Follow-up appointment with specialist

Diabetic foot bundle

• Presence or absence of Ulcers

• Presence or absence of infection (Fever, Low BP, Red and/or warm foot, pain without trauma)

• Presence or absence of ischaemia (Absent foot pulses, Cold or gangrenous foot)

• Presence or absence of deformity [Charcot Foot] (Foot does not look normal)

Positive result- manage appropriately

Impact (during initiative)

Care bundle delivered to ≥ 90% of patients

900 patients screened in the first 12 months b

Sustainability (After initiative)

Continued implementation of care bundle

Modified assessment used by surgical team

Diffusion

Care bundle by numerous NHS acute hospital trusts throughout England, supported by CQUIN payments

Clinical lead left the hospital and was continued by surgical lead

  1. aThe researcher (SG) was also a member of the implementation teams acting as a quality improvement advisor on behalf of the funder (NIHR CLAHRC Northwest London)
  2. bRepresenting approximately 2% of the inpatient population, a likely underrepresentation as current figures suggest inpatient prevalence of 5–30% [25]