Qualitative evaluation of a statewide antibiotic stewardship quality improvement sepsis intervention

Abstract Objective: From 2023–2024, the Maryland Statewide Prevention & Reduction Collaborative (SPARC) led an intervention targeting broad-spectrum antibiotic use for sepsis, aiming to identify the factors that influence the success of collaborative quality improvement (QI) programs. Design: Evaluation of a state collaborative run QI intervention. Participants: Acute-care facilities in Maryland. Methods: Participating sites developed and implemented sepsis-focused interventions with SPARC support, including tailored guidance and bimonthly office hours. Following the implementation of site-level interventions, sites participated in a mixed-methods assessment guided by the RE-AIM framework including brief qualitative interviews and a 6-month follow-up. Results: Eight hospitals implemented multi-component, multi-disciplinary sepsis-focused interventions. Facilities involved staff from up to six departments in the implementation of interventions. All sites noted the effectiveness of SPARC in supporting sites’ intervention activities, as well as the effectiveness of the site’s interventions in creating change. Sites identified barriers impacting the implementation of their interventions including lack of resources, administrative red-tape, and challenges changing culture. Facilitators included leadership support, having a structured intervention plan, and opportunities for peer-to-peer learning. Most sites were positive about SPARC’s role identifying interventions and support, utilized information from SPARC as part of their interventions, and found it useful to hear how other institutions implement antibiotic stewardship. Six months post-assessment, all sites were continuing intervention activities. Conclusions: This evaluation highlights how statewide QI collaboratives can be effective in promoting hospital-based antibiotic stewardship. Sites identified several facilitators and challenges that contributed to intervention implementation and highlighted the contributions of the SPARC team.