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BMJ. Feb 9, 2008; 336(7639): 294.
PMCID: PMC2234528

England launches scheme to encourage use of “care bundles”

England will launch a campaign this summer to promote the use of specific groups of evidence based interventions for hospital treatments that carry risk.

The idea of using groups of interventions, known as care bundles, was developed by the US Institute for Healthcare Improvement, which found that patients benefited more when interventions were grouped rather than carried out as individual procedures.

The campaign in England will coincide with celebrations to commemorate the 60th anniversary of the NHS, say the three organisers of the campaign, the National Patient Safety Agency, the Health Foundation, and the NHS Institute for Innovation and Improvement.

Stephen Ramsden, chief executive of Luton and Dunstable Hospital NHS Foundation Trust, told a conference organised by Healthcare Events last week that the campaign will encourage trusts to commit themselves to three particular care bundles.

The campaign could follow a similar agenda to the “100 000 lives” campaign in the United States, launched in December 2004, which aimed to reduce the number of unnecessary deaths in hospital by 100 000, Mr Ramsden told the conference in London.

Adopting the care bundles will be voluntary, he added. “We want people to feel inspired and motivated to do something, not be told they have to.”

He didn’t think that their being voluntary would reduce interest in them, and he said that organisations would receive “aid and support” to carry out the initiative, although he would not say whether they would receive money or other resources.

“People won’t be left to get on with it,” he said. “They will be supported in different ways, and we’ll need to have a faculty to show that this can be done in any hospital anywhere.”

Peter Lachman, a consultant for service redesign at Great Ormond Street Hospital for Children NHS Trust, London, agreed that forcing people to adopt care bundles was not the answer.

He said that in the US 100 000 lives campaign more than 3100 hospitals voluntarily enrolled and that they reduced the number of deaths by 120 000 lives, through the consistent use of six care bundles (BMJ 2006;332:1328-30 doi: 10.1136/bmj.332.7553.1328).

The follow-on “five million lives” campaign aims to avoid five million incidents of harm over two years (www.ihi.org/IHI/Programs/Campaign). Mr Lachman said that this campaign “went for 2000 hospitals, got 3500, and is now aiming for 4000.”

He said, “They are not doing it because the government is telling them to do it but because they want to be better.”

Some UK healthcare settings that have adopted care bundles have already made progress. Similar campaigns have started or will soon begin in the other three countries of the United Kingdom.

The Welsh critical care improvement programme has managed to successfully implement use of the ventilator acquired pneumonia bundle and the central line bundle in every adult intensive care unit in the country, said the programme’s manager, Chris Hancock.

“All the units have been more than 95% compliant with the ventilator bundle since September 2006, and there is a similar figure for the central line bundle,” he said. Central line infections had been reduced as a result. One unit had also reduced its methicillin resistant Staphylococcus aureus bacteraemias by 50%.

The North West London Hospitals NHS Trust has set up its own version of the US campaign, said Liz Robb, the trust’s director of nursing. It aimed to save 110 lives from April 2007 to March this year. The five bundles selected were for ventilator acquired pneumonia, Clostridium difficile, line sepsis, stroke, and chronic obstructive pulmonary disease.

“The numbers so far are 189 lives [saved], so we have exceeded our target, and it has really energised everyone,” she said.


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