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What risks to sustainability are identified throughout care bundle implementation and how can they be addressed? A
Laura Lennox1,2, Linda Eftychiou3, Dionne Matthew3
1Department of Primary Care and Public Health, Imperial College London, London, UK l.lennox@imperial.ac.uk.
BMJ Open
|June 12, 2021
Summary
This study explored challenges in sustaining heart failure care bundles (HFCB) and how multidisciplinary teams (MDTs) addressed them. Practical lessons are offered for embedding HFCB to improve patient care.
Area of Science:
- Healthcare Improvement
- Clinical Practice Guidelines
- Patient Care Management
Background:
- Despite national guidelines, heart failure (HF) care varies across UK hospitals.
- Care bundles are proposed for consistent optimal patient care, but sustainability challenges exist.
- Limited research guides the design and implementation of sustainable care bundles.
Purpose of the Study:
- To explore sustainability risks during heart failure care bundle (HFCB) implementation.
- To describe how a multidisciplinary team (MDT) addressed challenges to enhance HFCB sustainability.
- To provide practical lessons for sustaining care bundles in clinical practice.
Main Methods:
- A longitudinal mixed-method case study of an HFCB initiative (2015-2018).
- Utilized a standardized sustainability tool, observations, interviews, and document analysis.
- Thematic analysis of a qualitative database using a consolidated sustainability framework.
Main Results:
- Six key sustainability challenges were identified: infrastructure, coding, delivery, organizational fit, resources, and impact demonstration.
- The MDT implemented actions including business case development, usability improvements, consistent training, data reliability enhancement, monitoring integration, and practice embedding.
- Sustainability outcomes were assessed one year post-funding.
Conclusions:
- MDTs can address sustainability risks through targeted actions.
- Practical lessons derived from this case study can guide practitioners in embedding and sustaining care bundles.
- Successful HFCB implementation requires proactive strategies to overcome identified challenges.
Keywords:
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