Marjon Borgert

16 Chapter 1 Part II. Improving patient safety for critically ill patients in the ICU. The IHI developed the concept of care bundles to enhance the reliability of care and to improve the quality of care. 38,39 A care bundle is a structured way of improving care processes and patient outcomes. Bundles consist of a small set of three to ve evidence- based interventions for clinical processes or patient populations. The strength of bundling a small set of interventions is that the evidence-based care will be applied uniformly to every eligible patient. This may result in better patient outcomes than when the interventions are implemented individually. 38-41 Part II focuses on the development and implementation of evidence-based care bundles for ICU patients, and consists of the following ve chapters. In Chapter 4 , we use a systematic literature review to identify methods other than the IHI approach for supporting the development of new evidence-based care bundles for the ICU. Chapter 5 describes enteral nutrition delivery in the ICU. To nd ways of improving quality of care, it is important to identify patients at risk of malnutrition. In this study, which was conducted over a period of three years, we assessed the extent to which ICU patients received their daily enteral nutritional intake during ICU admission. This study could form the basis for developing strategies for supporting ICU sta in providing adequate enteral nutrition, thereby minimizing the risk of malnutrition. In Chapter 6 , we determine common strategies for implementing care bundles in the ICU and assess the e ects of these strategies on the quality of the implementation of these bundles. Chapter 7 describes the implementation of a transfusion care bundle for the delivery of red blood cells (RBC). In this implementation study, which had a quasi-experimental comparative study design, we investigated the di erence in the e ect on transfusion bundle compliance between monthly team-level audit and feedback (A&F) versus monthly team-level A&F plus timely individual A&F. In Chapter 8 we quantify the true e ect of the transfusion bundle by assessing, per transfusion, whether the decision to transfusewas basedona lower pre-transfusionhaemoglobin (Hb) level than thepatient’s individual preset Hb threshold. The objective of this study was to investigate whether the application of the transfusion bundle would reduce the number of inappropriate RBC transfusions in an ICU setting. The nal two chapters include the general discussion and summaries in both English and Dutch (Chapters 9 and 10).