Marjon Borgert

117 Implementation of care bundles in ICUs Study characteristics Overall, 72% (34/47) of the studies were conducted in a single hospital and 28% (13/47) in two or more hospitals. The 47 studies that were included reported about the implementation of 49 care bundles. Thirteen studies described the implementation of the central line bundle, 27 studies described implementation of the ventilator bundle and nine studies described the sepsis bundle implementation (Supplementary File 3). Two studies reported the implementation of two bundles, i.e. both central line and ventilator bundle 35,39 and two studies were merged because they continued the implementation in the same hospital. 60,61 One study reported detailed information about the study participants, i.e. bundle users. 50 They described variables as age, gender and years of work experience. The remaining studies only mentioned the type of disciplines that used the bundle without reporting additional information about the users. Studies about central line implementation used pre/post designs in 46% (6/13), prospective cohort studies in 39% (5/13) and retrospective designs in 15% (2/13). Studies about the implementation of the ventilator bundle were conducted with pre/post designs in 48% (13/27), with prospective cohorts in 33% (9/27), as a longitudinal study in 4% (1/27) and as both interrupted time series and retrospective designs in 7% (2/27). For the studies about sepsis bundle implementation pre/post designs were used in 56% (5/9) and prospective cohort designs in 44% (4/9). A detailed description of relevant study characteristics is shown in Supplementary File 3, which is organized by type of bundle and study design. Number of care bundle elements Boththenumberof elementsperbundleandthe typesof element varied(Supplementary File 4). Three types of central line bundles were described: 1) central line bundle in general (n=8), 2) insertion bundle (n=5) and 3) maintenance bundle (n=3). The range of elements within the central line bundle varied from three to seven elements (Supplementary File 4). In 8/16 central line bundles ve elements were included and most of these elements were derived from the original IHI bundle. 5 The number of elements per ventilator bundle ranged from four to seven. In 12 studies (44%, 12/27) the bundle consisted of four elements and in three studies 50,58,62 (11%, 3/27) the bundle contained seven elements (Supplementary File 4). The most common element was ‘elevation of the head-of-the-bed’ in 96% (26/27), followed by deep venous thrombosis prophylaxis and peptic ulcer prophylaxis in 78% (21/27). The sepsis bundle was divided into the resuscitation bundle (n=5) and management bundle (n=6). In two studies 67,68 the general sepsis bundle contained six and 11 elements respectively. The resuscitation bundle has a range of ve to seven elements while the management bundle contains two to seven elements (Supplementary File 4).