Dear Editor,

Rangachari et al1 present a fascinating account of their approach to drive health care quality by using care bundle methodology. Their approach seems to have generated good results, but some hard evidence to back up their findings was not reported in their article.

First of all, the authors claim statistically significant declines in catheter days of more than 30% and catheter-related bloodstream infections rates of more than 65%. However, the authors do not state whether the reductions reported are absolute or relative reductions; nor do they state what statistical test they used to prove this; nor indeed do they cite at what level of statistical significance this was proved (P levels or confidence limits are not mentioned). They claim that rates of catheter-related bloodstream infections remained low in the following year but do not cite the prevalence of such infections in that year. The authors cite cost savings of at least $840 000 as a result of reduced numbers of infections but do not give any information on how they arrived at this figure.

Second, the authors claim that the $840 000 savings would have far outstripped the cost of their intervention. However, they do not state what the cost of their intervention actually was. It is tempting to believe that the authors are correct and that overall savings were made-but the cost of the intervention was probably not negligible. They correctly used a programmatic approach to change management, but this approach requires time and funding that ideally should have been defined and reported. Perhaps they could do so in a follow-up report to their initial analysis.

Yours Sincerely

Kieran Walsh, FRCPI

BMJ Learning, London, United Kingdom

[email protected]

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