Use of patient-relevant outcome measures to assess the long-term effects of care bundles in the ICU: a scoping review protocol

Abstract

IntroductionThere is only moderate adherence to evidence-based practice in critical care. Care bundles can be used to increase adherence to best clinical practice. Components of bundle interventions, bundle implementation rates, barriers and facilitators of bundle implementation, and the effect of care bundles on short-term patient outcomes such as intensive care unit (ICU) mortality all appear to be regularly studied. However, over the last years, critical care research has turned towards long-term patient-relevant outcomes after discharge from the ICU. To our knowledge, there is no systematic overview on the long-term effect of care bundle implementation on patient-relevant outcomes. We present a protocol for a scoping review of the available literature on the effect of the implementation of care bundles in the ICU on long-term patient-relevant outcomes.Methods and analysisThis scoping review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines and the Arksey and O’Malley framework. The recommendations of the Joanna Briggs Institute for Scoping Reviews will also be followed. A systematic literature research will be performed using electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, CDSR and CENTRAL). A preliminary search has been conducted on 1 September 2021, yielding 1929 entries. The main search, data extraction and charting has not been started yet. This scoping review will provide an overview of the long-term patient-relevant outcomes that have been used to assess the implementation of care bundles in the ICU. It will be the first study to summarise the long-term impact of care bundles for critically ill patients and identify research gaps to inform future research.Ethics and disseminationDue to the utilisation of already published primary studies, ethical approval is dispensable. Results of this work will be published in a peer-reviewed journal.

Effect of ICU care bundles on long-term patient-relevant outcomes: a scoping review

“…Strengths of this scoping review include the rigorous methodology: First, the review was preregistered on Open Science Framework 31 and its protocol was published. 32 Second, the search strategy was developed according to PRESS recommendations. 34 Third, we performed an extensive hand search to collect records missed by our search strategy.…”

“…While this expertise relates to many areas of the review, the clinical focus may have biased our results. Finally, as this was not intended in our study protocol, 32 we did not synthesise the effects of the included studies. A synthesis could be performed in future meta-analyses, despite the challenges due to the heterogeneity of implemented bundles, outcomes, instruments and time points.…”

“… 30 The scoping review was pre-registered on Open Science Framework, 31 and the protocol has been published. 32 …”

“…We adhered to the Arksey and O’Malley framework28 and additions,29 and the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping-Reviews checklist (online supplemental file 1). 30 The scoping review was pre-registered on Open Science Framework,31 and the protocol has been published 32…”

Feasibility and impact of a postpartum hemorrhage emergency care package using a bundle approach in Migori County, Kenya

“…Bundling interventions is meant to simplify and standardize quality care across health systems to optimize patient outcomes. Initially applied as a quality improvement framework in intensive care unit settings, the bundle approach has since been adopted across numerous other disciplines including obstetric emergency care 2,3 …”