Marjon Borgert

70 Chapter 4 only one method for one process step was reported, i.e. conducting a literature review to identify risks in step 1. 31 In 89% (16/18), a literature review was used as a method to design bundles. In 75% (12/16) of these studies, a review was only used for identifying problems. In 12,5% (2/16), a review was used to underpin elements with evidence. In 12,5% (2/16), a bundle development process was described in general and that systematic reviews could be used to nd evidence for the bundle elements. In 17% (3/18), a narrative report was written about bundles in general. Quality improvements were described in 39% (7/18), methodological studies in 17% (3/18), before and after designs in 11% (2/18). The remaining designs were one randomized trial, one case series and one observational study.