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Patient safety expert, Carol Haraden, PhD, clarifies what a "bundle" is and is not, and suggests tips for using bundles most effectively to get results in improvement initiatives. While the allure of this tool is undeniable, quality teams should resist the impulse to label any list of good changes a bundle.

10 IHI Innovations to Improve Health and Health Care

This curated publication highlights 10 ideas that have emerged from IHI's systematic 90-day innovation approach, including reflections on the Triple Aim, the concept of a health care Campaign, the Breakthrough Series Collaborative model, and other frameworks and fresh thinking that have been replicated around the world.

WIHI: A Partnership to Reduce Deaths from Sepsis

January 24, 2013 | This WIHI explores how North Shore–Long Island Jewish Health System has reduced its sepsis mortality rate significantly, and what others can learn from their progress.

How-to Guide: Prevent Obstetrical Adverse Events

This How-to Guide describes the essentials elements of preventing obstetrical adverse events, including the safe use of oxytocin and key evidence-based care components in the IHI Perinatal Bundles.

Severe Sepsis Bundles

The Severe Sepsis Bundles include the Severe Sepsis 3-Hour Rescuscitation Bundle and the 6-Hour Septic Shock Bundle. The Severe Sepsis Bundles have been revised in conjunction with the updated 2012 International Guidelines for Management of Severe Sepsis and Septic Shock.

Using Care Bundles to Improve Health Care Quality

This IHI white paper describes the history, theory of change, design concepts, and outcomes associated with the development and use of bundles — a small set of evidence-based interventions for a defined patient population and care setting — and reflects on learning over the past decade.

Methods for Reducing Sepsis Mortality in Emergency Departments and Inpatient Units

North Shore-LIJ Health System (now Northwell Health) launched a strategic partnership with the Institute for Healthcare Improvement to accelerate the pace of sepsis improvement, focusing initially on sepsis recognition and treatment in emergency departments (EDs). The health system reduced overall sepsis mortality by approximately 50 percent in a six-year period and increased compliance with sepsis resuscitation bundle elements in the EDs and inpatient units in 11 acute care hospitals.

Reducing Hospital Mortality Rates (Part 2)

In the first white paper, IHI introduced an analytical tool for understanding hospital mortality rates (hospital standardized mortality ratio, or HSMR). This second white paper presents the experience of hospitals that implemented evidence-based interventions proven to reduce mortality and their early results.

Profiles in Improvement: Katharine Luther, Vice President, IHI

IHI Vice President Kathy Luther describes her career in health care quality improvement, and how her current IHI work includes getting finance and clinicians to work together to impact cost and quality.

Ventilator Bundle Compliance

Compliance with the Ventilator Bundle is defined as the percentage of intensive care patients on mechanical ventilation for whom all four of the elements of the Ventilator Bundle are documented on daily goals sheets and/or elsewhere in the medical record.

Ventilator-Associated Pneumonia (VAP) Rate per 1,000 Ventilator Days

Ventilator-associated pneumonia (VAP) is defined as pneumonia in a patient intubated and ventilated at the time of or within 48 hours before the onset of the event. (There is no minimum period of time that the ventilator must be in place in order for the pneumonia to be considered ventilator-associated.) The VAP rate is defined as the number of ventilator-associated pneumonias per 1,000 ventilator days

Project JOINTS: What Factors Affect Bundle Adoption in a Voluntary Quality Improvement Campaign?

This article examines how hospital adherence to quality improvement (QI) methods and hospital engagement with a large-scale QI campaign — Project JOINTS, an IHI-led initiative — could facilitate the adoption of an enhanced prevention bundle designed to reduce surgical site infection (SSI) rates after orthopaedic surgery (hip and knee arthroplasty).

Idealized Design of Perinatal Care

Reviews of perinatal care have consistently pointed to failures in communication among the care team and documentation of care as common factors in adverse events that occur in labor and delivery. This white paper provides detail about IHI's Idealized Design process and examines some of the initial work of the Idealized Design of Perinatal Care innovation project.

Did a Quality Improvement Collaborative Make Stroke Care Better?

In this study, 24 NHS hospitals in the Northwest of England were randomly allocated to participate either in Stroke 90:10, a quality improvement collaborative (QIC) based on the IHI Breakthrough Series (BTS) model, or in a control group giving normal care. Some aspects of stroke care modestly improved during the collaborative.

Early Goal Directed Therapy Reduces Sepsis Complications and Mortality

At PeaceHealth/St. Joseph Hospital (Bellingham, Washington, USA), a partnership between the ICU and the ED, as well as ongoing surveillance and feedback to individual providers, reduced mortality related to severe sepsis and septic shock from 41 to 50 percent in the two months prior to implementation to an average of 17 percent after implementation of the Sepsis Resuscitation and Sepsis Management Bundles.

How-to Guide: Prevent Ventilator-Associated Pneumonia (Pediatric Supplement)

This How-to Guide specifically tailored for pediatrics describes key evidence-based care components for preventing ventilator-associated pneumonia.

Reducing Average Length of Stay on Mechanical Ventilation Using Bundles and Mobility

University of Rochester Medical Center targeted specific elements in the Ventilator and Central Line Bundles to increase compliance, thereby reducing ventilator-associated pneumonia, reducing CRBSIs, and decreasing average length of stay. In addition, a mobility initiative helped the team achieve daily sedation interruption and development of a new bundle further reduced CRBSIs.

Creating and Implementing a Bundle to Reduce VAP in the NICU

Central DuPage Hospital reduced VAP in the NICU from a rate of 13.02 in 2004 to a rate of 5.43 in 2005 by implementing a neonatal ventilator bundle, reducing accidental extubations and a reinforcing handwashing.

Zero VAP Rate in the ICU by Reducing Time on Sedation

Mercy Hospital (Buffalo, New York, USA) has sustained zero ventilator-associated pneumonias in the ICU by reliably implementing the IHI Ventilator Bundle, with a special focus on reducing the amount and duration of sedation for patients on ventilators in the ICU.

A Team Gives Mobility to Ventilated Patients

Patients in critical care are usually kept immobile and heavily sedated, but there’s growing evidence that mobility can help a patient's long-term recovery.

Understanding Bundles: An IHI Faculty Conversation

IHI faculty for the Rethinking Critical Care seminar discuss and try to clarify some important and often misunderstood points about implementing care bundles (such as the Ventilator Bundle and the Central Line Bundle).

Augmentation Bundle Compliance Data Collection Tool

Use this data collection tool when implementing the Augmentation Bundle, a component of the IHI Perinatal Bundles, to measure Augmentation Bundle Compliance.

Elective Induction Bundle Compliance Data Collection Tool

Use this data collection tool when implementing the Elective Induction Bundle, a component of the IHI Perinatal Bundles, to measure Elective Induction Bundle Compliance.

JAMA Patient Page: Ventilator-associated pnuemonia

This resource presents information on risk factors, prevention, diagnosis and testing, and treatment of ventilator-associated pneumonia.

Annotated Bibliography for Preventing Ventilator-Associated Pneumonia

This annotated bibliography presents selected literature for the elements of the IHI Ventilator Bundle and preventing ventilator-associated pneumonia.