P66 Breaking down barriers: a survey on challenges in completing healthcare bundles

<h3>Introduction</h3> Healthcare bundles, such as the Decompensated Cirrhosis Care Bundle, are evidence-based tools designed to streamline and improve patient care. Research suggests that using healthcare bundles may improve patient outcomes, however local audits often show that completion rates are inconsistent.¹ Our team recently completed a quality improvement project aiming to improve the use of the Decompensated Cirrhosis Discharge Bundle in hospitals in the Northern region. We identified that completion rates were low, and remained so, even after interventions to provide education and raise awareness. To complete the next cycle of this audit we conducted a survey looking at barriers to completing healthcare bundles. By identifying obstacles to completing bundles with the next cycle we can look to improve these and subsequently improve compliance. <h3>Aims and Methods</h3> We created a survey looking at whether participants had used the decompensated discharge bundle and if they found healthcare bundles to be useful. Staff were contacted via various channels, including deanery mailing lists, and encouraged to share the survey more widely in order to access as many people as possible. Within the survey we asked participants what barriers had prevented them using healthcare bundles in practice. <h3>Results</h3> 64 doctors completed the survey from 19 different trusts. 20 of these responses were from doctors currently working in Newcastle hospitals. Ranging from F1 to consultant. 93% of participants had completed a healthcare bundle before and 44% found bundles to be extremely helpful. 67% of participants had specifically heard of the cirrhosis discharge bundle but only 42% had completed the bundle in practice. When asked about barriers to completing healthcare bundles 63% cited lack of awareness about the bundle being the issue. Other common barriers were lack of training (50%); heavy workload; poor staffing (43%) and IT issues (33%). 98% agreed that ward doctors (F1-ST3) are best placed to complete healthcare bundles followed by specialty registrars (71%) and specialist nurses (66%). <h3>Conclusion</h3> Our survey shows that most doctors value healthcare bundles and find them helpful. This suggests that the barrier to completion does not lie in the functionality but in logistical issues when filling this out. The survey highlighted the main limitations to completing bundles include lack of awareness and lack of training. This information can help us guide future education and training. By improving these barriers to completing healthcare bundles we can increase compliance and improve outcomes. <h3>Reference</h3> Smethurst K, Gallacher J, Jopson L, Majiyagbe T, Johnson A, Copeman P, <i>et al</i>. Improved outcomes following the implementation of a decompensated cirrhosis discharge bundle. <i>Frontline Gastroenterology</i> 2021 Dec 15;flgastro-2021–102021.