Process mapping of a collaborative quality improvement study to optimise the use of antibiotics in intensive care...

To systematically document the operational components, barriers, facilitators, and solutions of a quality improvement collaborative for antibiotic stewardship in intensive care units (ICUs) in the public sector of Argentina, using the Pathfinder methodological framework.

Retrospective, descriptive observational study using mixed methods. Data sources included a documentary review of protocols, standard operating procedures, monitoring reports, and host study publications; an online survey with closed and open-ended questions administered to research team members; and triangulation with findings from the host study's previously published process evaluation, structured according to Normalisation Process Theory. Integration was performed using the Pathfinder Tracker. Analysis combined descriptive statistics with content analysis of open-ended responses.

Eleven stages of the research process were mapped, from question formulation to dissemination, with an estimated total effort of approximately 1,020 person-hours. The stages with the highest perceived difficulty (4/5) were ethical and institutional approvals, data collection, analysis, and dissemination, which together accounted for approximately 50% of the total estimated effort. Barriers were identified across three domains: institutional and regulatory (heterogeneity of ethical requirements, absence of stable local coordinators, publication costs); operational and technical (complex data collection forms, displacement of implementation focus due to the burden of data collection, variable connectivity); and human resources and capacity (clinical workload, staff turnover, insufficient training in implementation science). Solutions included a collaborative format with mentoring, agile communication via accessible digital tools (REDCap, WhatsApp, Zoom), and the use of theoretical frameworks for structuring (NPT, CFIR).

The Pathfinder framework enabled a systematic and transferable reconstruction of the host study's processes, revealing barriers and solutions that conventional results reports do not capture. The findings are relevant for research teams in middle-income countries designing quality improvement collaboratives in complex hospital settings.