Assessing the impact of a 'bundle of care' approach to bacteraemia in a tertiary hospital.

Background: bacteraemia is associated with significant morbidity and mortality. There is evidence that standardised care bundle implementation may improve the rates of appropriate investigations and improve overall management. A bacteraemia care bundle was introduced at Christchurch Hospital, New Zealand in early 2014. We assessed the impact of the intervention on the management and outcome of bacteraemia.

Methods: A cohort study of cases of bacteraemia was conducted following standardised care bundle introduction. Prospective enrolment of post-intervention patients occurred from 1 January 2014 to 30 June 2015, with retrospective review of pre-intervention cases from 1 January 2009 to 31 December 2013.

Results: In the pre-intervention period 447 patients had at least one episode of bacteraemia compared to 151 patients in the post-intervention period. The two groups were similar by gender, ethnicity, and age. Significant increases in Infectious Diseases consultation rate (86.6% vs 94.8%; p=0.009), echocardiography (76.3% vs 96.3%; p<0.001), urine culture (74.0% vs 91.9%; p<0.001), follow up blood cultures (44.2% vs 83.0%; p<0.001), and at least 2 weeks of parenteral therapy (83.5% vs 92.9%; p=0.014) were observed after introduction of the bundle. There were no significant differences in rates 30-day mortality (18.6% vs. 20.5%; p=0.596), but there was a reduction in episodes of relapsed infection in the post-intervention cohort (7.4% vs 1.3%; p=0.004).

Conclusion: An integrated care bundle for the management of bacteraemia resulted in increased use of quality of care indicators and infectious diseases review and improved patient outcome.