A bundle is described as a structured way of improving the processes of care and patient outcomes: a set of evidence-based practices — generally three to five — that, when performed collectively and reliably, have been demonstrated to improve patient outcomes (Institute for Healthcare Improvement, 2010). It is not simply a list of desirable changes.
- All of the elements are necessary and must be performed together.
- The changes are all based on randomized controlled trials, what we call Level 1 evidence.
- A bundle focuses of how to provide the care, not what care to provide.
- Bundle changes must occur at a specific time and place; every patient, every time, with complete consistency.
- A bundle belongs to a person or team, so there is a strong elenment of accountability.
In a bundle, the measures are all-or-none (Nolan & Berwick, 2006). All practices must be applied all the time; three out of four practices would not capture the spirit of the concept.
For an example of a bundle, see Central Line Bundle. This is a set of five ideas to help prevent “catheter-related blood stream infections,” deadly bacterial infections that can be introduced through an IV.