An evaluation of ‘care bundles’ as a means of improving hospital care for patients with acute COPD: a case-study approach

Problem

‘Care bundles’ are standardised sets of evidence-based interventions used for patients at the point of hospital admission and discharge. We aimed to qualitatively evaluate the role of care bundles in improving acute hospital care in England and Wales for adults with COPD.

Approach

A case-study approach was used as part of a mixed-methods, controlled before-and-after study, to assess the effectiveness of COPD ‘care bundles’. Interviews (n= 114) with healthcare professionals, patients and carers were conducted alongside observation of patient care at six locations – four implementation sites where care bundles were used, and two comparator sites which provided ‘usual care’. Data were analysed thematically.

Findings

Healthcare professionals viewed care bundles positively- standardising working practices and patient care, supporting a clear pathway for patients, facilitating communication between teams, and identifying support post-discharge. They were also perceived as a means for embedding reliable, sustainable quality improvement. Patients and carers highlighted the need for support at the point of discharge, as well as timely follow-up in the community. Discharge bundles created opportunities to discuss available services and potential management options. However, we also observed the use of discharge checklists at comparator sites. This is evidence of ‘bundling by another name' i.e. almost identical processes and activities taking place at implementation and comparator sites.

Consequences

Care bundles are valued by healthcare professionals, patients and carers and can support quality improvement in COPD care. The distinction between implementation and usual care is not always clearly defined.