The Evidence-Based ‘Bundles’ Behind Those Tiny, Swaddled ‘Bundles’

By Kristine Hartvigsen on March 13th, 2017

Hundreds of thousands of adorable ‘bundles of joy’ arrive on our planet every day. A safe and healthy birth is a celebration indeed. But it doesn’t all happen by kismet; long-term study, planning, medical consensus, and training support healthy deliveries. Coincidentally, the obstetrics industry term for evidence-based best practice guidelines, or toolkits, is “bundles.”

The efficacy of maternal safety bundles is well-established. Most recently, researchers from the California Maternal Quality Care Collaborative (CMQCC) found that collaboratively using maternal safety toolkits could reduce the incidence of obstetric hemorrhage. In the United States, postpartum hemorrhage occurs in about 2-5% of births. The hospitals CMQCC studied reduced incidents of severe hemorrhage by 21% after the first year of toolkit utilization and 28% after the second year, suggesting that safety and quality improvement are a cumulative process.

Their results were published recently in the American Journal of Obstetrics & Gynecology.

March 12-18 is National Patient Safety Week. The National Patient Safety Foundation (NPSF), which is celebrating 20 years of operation in 2017, is a primary sponsor of the annual observance through its United for Patient Safety Campaign. The NPSF is asking participants to address patient safety as a serious public health issue and inviting clinicians and consumers alike to take a pledge expressing support for patient safety.

As the industry leader in patient safety and quality improvement, Ob Hospitalist Group (OBHG) requires all clinicians to regularly maintain their proficiency in the latest OB/GYN patient safety issues via continuing education, and all new clinical employees are required to complete several online courses (or bundles) in electronic fetal monitoring and perinatal safety before they begin their first shift in a partner hospital.

Without question, healthcare providers have made significant improvements in patient safety. According to the U.S. Department of Health and Human Services, the incidence of hospital-acquired conditions decreased 21% from 2010 and 2015. A hospital-acquired condition is defined as a condition a patient develops while in the hospital being treated for something else. These conditions can result from things like adverse drug events, catheter-associated urinary tract infections, central line associated bloodstream infections, pressure ulcers, and surgical site infections. This five-year reduction has saved an estimated $28 billion in healthcare costs.

The Agency for Healthcare Research and Quality (AHRQ) has published dozens of toolkits addressing many healthcare-related topics on its website. AHRQ also has published 10 evidence-based tips to prevent adverse events online. One tip suggests reducing potentially preventable readmissions by assigning a case manager to work with patients and other staff to ensure discharged patients understand directions and prescription details and schedule follow-up care. An estimated 15-20% of patients experience an adverse event within three weeks of being discharged from the hospital. Another tip advises preventing venous thromboembolism (VTE) by using an established, proven VTE protocol. AHRQ also encourages healthcare facilities to work with Patient Safety Organizations (PTOs) to report their patient safety incidents to be shared with others in the PTO to avoid any recurrence of avoidable errors.

AHRQ also recommends building better healthcare teams and rapid response systems by training hospital staff to communicate effectively as a team. Toward that goal, the organization has published a free, customizable toolkit called TeamSTEPPS™, which stands for Team Strategies and Tools to Enhance Performance and Patient Safety. Similarly, the American College of Obstetricians and Gynecologists (ACOG) publishes extensive safety tools and checklists online.

During National Patient Safety Week, the NPSF invites interested people to participate in the following:

• On Tuesday, March 14, from 1-2 EST, NPSF (@NPSF) will host a Twitter Chat on Patient Safety. Anyone can participate using the hashtag #psaw17chat.
• On Wednesday, March 15, from 2-3 EST, NPSF is hosting a complimentary webcast titled “The Voice of the Patient and the Public.” There is no charge, but registration is required at
• Throughout the week, NPSF is encouraging those on social media to demonstrate the fact that “We are all patients” by posting photos of themselves in hospital gowns or in patient care settings and using the hashtag #WeAreAllPatients.

At OBHG, a passion for people and commitment to patient safety and quality improvement are part of our culture. For safety programs anywhere to succeed, it is imperative that healthcare organizations similarly establish their own safety cultures, regularly utilize bundles, toolkits, and best practices, and consistently demonstrate unwavering dedication to their patients every day.

This blog provides general information and discussion about healthcare-related subjects. The content and linked materials provided are not intended and should not be construed as medical advice. If the reader is an expectant mother with a medical concern, she should consult with an appropriately licensed physician or healthcare provider.

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