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Abstract
Background Care bundles are sets of evidence-based interventions to improve quality of hospital care at admission and discharge. Within a wider multi-method evaluation of care bundles for adults with an emergency admission for acute exacerbations of chronic obstructive pulmonary disease, a qualitative study was conducted. The aim was to evaluate how bundles were used, and healthcare professionals’ experiences of the impact of bundles on the process of care delivery.
Methods Within the wider evaluation, four acute hospitals that were using COPD care bundles were purposefully sampled for geographical variation. Qualitative data were gathered through non-participant observation of patient care and interviews with healthcare professionals, patients and carers. This paper reports a thematic analysis of data from observation and interviews with professionals.
Results Healthcare professionals generally experienced care bundles as positive for standardising working practices and patient care, valuing how bundles could support a clear care pathway for patients, enable transitions between settings and identify postdischarge support required by patients. Successful use of bundles was perceived as more likely with the presence of either (or both) a clinical champion for bundles and system-based initiatives such as financial incentives, within a local culture of quality improvement. Challenges in accurately diagnosing COPD hampered bundle use, including delivery of bundles to those subsequently considered ineligible, or missed opportunities to deliver admission bundles to those with COPD.
Conclusion Care bundles shape admission and discharge care processes for patients with COPD, from the perspective of staff involved in their delivery. However, different organisational, staff and clinical factors aid or hinder bundle use in an acute hospital context, suggesting potentially resolvable reasons for variable implementation of bundles. Finally, bundles may enhance staff experience of care delivery, even if the impact on patient outcomes remains uncertain.
- pulmonary rehabilitation
- COPD exacerbations
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Footnotes
Contributors AS and SP designed the study. KM and AK collected and analysed the data, with support from AS and SP. AS, KM and SP drafted the paper. All authors read and approved the final manuscript.
Funding This work was supported by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) Programme, project number 12/130/53. The research was hosted by NHS Bristol and was designed and delivered in partnership with the Bristol Randomised Trials Collaboration (BRTC), a UK Clinical Research Collaboration (UKCRC) registered Clinical Trials Unit (CTU). The views expressed are those of the authors and not necessarily of the NHS, the NIHR or the Department of Health and Social Care.
Competing interests SP is a general practitioner, and JC is a hospital consultant working in the field of respiratory medicine. JC worked with colleagues at the British Thoracic Society to design and evaluate care bundles as an intervention to improve outcomes in different respiratory conditions, including chronic obstructive pulmonary disease, pneumonia and asthma. SP is a member of the National Institute for Health Research (NIHR) Health Services and Delivery Research Researcher-led Panel, from 2017 to date. SJ runs an independent consultancy for public and charitable sector clients, providing strategy and organisation development, leadership coaching and facilitation.
Patient consent for publication Not required.
Ethics approval Ethical approval was given by the South West (Frenchay) Research Ethics Committee (study reference 14/SW/1057). All participants consented to be interviewed and/or observed, and for their anonymised data to be published in study outputs.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Selected relevant data are presented in the article. We are unable to provide access to the original data as participants did not consent to open access to their data for future analysis.