Marjon Borgert

113 Implementation of care bundles in ICUs whether a study reported about one of these two inclusion criteria, it was selected for full-text screening. Full-text articles were thoroughly reviewed and studies were included if all three selection criteria were clearly described. Data extraction Data extraction was performed by using a pre-de ned data-abstraction sheet. The following data were extracted: author, publication year, research design, setting, participants, i.e. bundle users such as nurses or physicians, type of care bundle, implementation strategies, bundle elements, compliance rates and the type of compliance measurements. Two reviewers performed data extraction independently. In case of discrepancies, consensus was reached by discussion. A third reviewer was consulted in case consensus could not be reached. Quality assessment A great variety exists in quality assessment tools for non-randomized studies. A valid checklist to assess the quality is currently lacking. 17 However, Downs and Black designed a checklist to evaluate the methodological quality of studies with both randomized and non-randomized designs. 18 We have used this tool to assess the risk of bias among the included studies. Checklist itemnumber 27 about sample size calculation was simpli ed to a score of 0 (no sample size calculation) or 1 (sample size calculation reported). Therefore, a maximum score of 28 could be achieved for randomized studies and 25 for non-randomized studies. The following cut-o points have been reported to categorize studies by quality: excellent (26–28), good (20–25), fair (15–19) and poor (≤ 14). 19,20 Two reviewers conducted the quality assessment independently. Disagreement between the reviewers was resolved through discussion. A third reviewer was involved in case of disagreement. Implementation strategies The di erent strategies that were used for implementation were categorised using the taxonomy developed byThe Cochrane E ective Practice andOrganisation of Care Group (EPOC) for dissemination and implementation strategies (Table 1). 21 Where more than one method was used within one of the categories this was measured as one strategy, i.e. if checklists and dashboards were used, this was categorised as a ‘reminder’ and was therefore measured as only one strategy.