{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:57:32Z","timestamp":1771930652145,"version":"3.50.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000062","name":"NIDDK","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sepsis is a burdensome and costly condition and a leading cause of death in acute care centers. Guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework, the Assessment of Implementation Methods in Sepsis (AIMS) study is an ongoing hybrid type 2 effectiveness-implementation study. One co-primary aim is to compare two multi-component sepsis \u201cbundles\u201d\u2014one accomplished within 3-h and one within 1-h\u2014and their effects on mortality and related health outcomes. The other co-primary aim is to assess implementation strategies that support bundle implementation within emergency departments. Implementation strategies include learning collaboratives, provision of educational materials, audit and feedback reports, capturing and sharing local knowledge, and technical assistance. The goal of this implementation-focused process evaluation was to identify barriers and facilitators to the implementation process and to develop subsequent adaptations to enhance implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multi-method data collection and analysis was undertaken in the Implementation stage. The two champions (one nurse and one physician) from each of the 18 AIMS study sites were invited to participate in semi-structured interviews. Learning collaborative attendees completed quantitative satisfaction surveys. After analysis, potentially impactful and feasible modifications to the implementation process were identified, documented using the FRAME-IS, and enacted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Synthesis of 24 interviews and 19 surveys indicated that the implementation strategies were generally executed as planned and respondents were satisfied with the implementation process. Monthly learning collaboratives included helpful topics and facilitated inter-site networking and learning. Educational materials were valuable resources for onboarding and ongoing reference, and monthly audit and feedback reports helped to quantify progress and benchmark with other AIMS sites. Barriers and related adaptations were focused on simplifying and streamlining touchpoints and materials, further supporting inter-site networking and learning, and increasing knowledge of and access to resources. Fifteen adaptations (content\u202f=\u202f7; context\u202f=\u202f4; evaluation\u202f=\u202f2; training\u202f=\u202f1; and multi-purpose\u202f=\u202f1) were made to increase the acceptability, appropriateness, or feasibility of the implementation effort (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f12), improve fidelity to bundles (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f2), and to increase adoption of bundles (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f1).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The implementation strategies were well-received and site-specific feedback led to modifications. The summative evaluation will provide insight into if and how modifications enhanced implementation efforts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:uri>ClinicalTrails.gov<\/jats:uri>\n                      , Identifier NCT05491941.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1748494","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T06:44:37Z","timestamp":1770273877000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["From feedback to action: a process evaluation of implementation strategies for sepsis bundles in emergency departments"],"prefix":"10.3389","volume":"13","author":[{"given":"Jacqueline F.","family":"Hayes","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University","place":["Providence, RI, United States"]},{"name":"Weight Control and Diabetes Research Center, The Miriam Hospital","place":["Providence, RI, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah E.","family":"Frank","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University","place":["Providence, RI, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aden","family":"Littlewood","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University","place":["Providence, RI, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda E.","family":"Guzman","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University","place":["Providence, RI, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen M.","family":"Terry","sequence":"additional","affiliation":[{"name":"Lightning Strategies LLC","place":["Northport, NY, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christa","family":"Schorr","sequence":"additional","affiliation":[{"name":"Cooper Research Institute \u2013 Critical Care, Cooper University Healthcare","place":["Camden, NJ, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Portelli","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The Warren Alpert Medical School of Brown University","place":["Providence, RI, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary","family":"Phillips","sequence":"additional","affiliation":[{"name":"Center for Biostatistics, The Ohio State University","place":["Marion, OH, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lori","family":"Harmon","sequence":"additional","affiliation":[{"name":"Society of Critical Care Medicine","place":["Mount Prospect, IL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessyca","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Department of Pulmonary, Critical Care and Sleep Medicine, Warren Alpert Medical School at Brown University","place":["Providence, RI, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Evans","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington","place":["Seattle, WA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. Phillip","family":"Dellinger","sequence":"additional","affiliation":[{"name":"Critical Care Division, Cooper University Health Care, Cooper Medical School of Rowan University","place":["Camden, NJ, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitchell M.","family":"Levy","sequence":"additional","affiliation":[{"name":"Department of Pulmonary, Critical Care and Sleep Medicine, Warren Alpert Medical School at Brown University","place":["Providence, RI, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1001\/jama.2017.13836","article-title":"Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014","volume":"318","author":"Rhee","year":"2017","journal-title":"JAMA"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1159\/000477419","article-title":"Update of sepsis in the intensive care unit","volume":"9","author":"Genga","year":"2017","journal-title":"J Innate Immun"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1097\/01.ccm.0000206112.32673.d4","article-title":"Implementation of an evidence-based \u201cstandard operating procedure\u201d and outcome in septic shock","volume":"34","author":"Kortgen","year":"2006","journal-title":"Crit Care Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.1097\/01.ccm.0000259463.33848.3d","article-title":"Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality","volume":"35","author":"Nguyen","year":"2007","journal-title":"Crit Care Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1623","DOI":"10.1007\/s00134-014-3496-0","article-title":"Surviving Sepsis campaign: association between performance metrics and outcomes in a 7.5-year study","volume":"40","author":"Levy","year":"2014","journal-title":"Intensive Care Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1001\/jama.2018.9071","article-title":"Association between the New York sepsis care mandate and in-hospital mortality for pediatric sepsis","volume":"320","author":"Evans","year":"2018","journal-title":"JAMA"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e62215","DOI":"10.7759\/cureus.62215","article-title":"One-hour bundle protocols for surgical sepsis and septic shock in surgical intensive care unit: clinical outcome aspects in the Thai context","volume":"16","author":"Boontoterm","year":"2024","journal-title":"Cureus"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1007\/s00134-018-5085-0","article-title":"The surviving sepsis campaign bundle: 2018 update","volume":"44","author":"Levy","year":"2018","journal-title":"Intensive Care Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1136\/emj.2009.089581","article-title":"Impact of the surviving Sepsis campaign on the recognition and management of severe sepsis in the emergency department: are we failing?","volume":"28","author":"Cronshaw","year":"2011","journal-title":"Emerg Med J"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1097\/CCM.0000000000002949","article-title":"Delay within the 3-hour surviving sepsis campaign guideline on mortality for patients with severe sepsis and septic shock","volume":"46","author":"Pruinelli","year":"2018","journal-title":"Crit Care Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1016\/j.jemermed.2012.07.084","article-title":"Impact of sepsis bundle strategy on outcomes of patients suffering from severe sepsis and septic shock in China","volume":"44","author":"Wang","year":"2013","journal-title":"J Emerg Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1186\/s13063-023-07644-y","article-title":"Assessment of implementation methods in sepsis: study protocol for a cluster-randomized hybrid type 2 trial","volume":"24","author":"Frank","year":"2023","journal-title":"Trials"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1007\/s10488-010-0327-7","article-title":"Advancing a conceptual model of evidence-based practice implementation in public service sectors","volume":"38","author":"Aarons","year":"2011","journal-title":"Admin Pol Ment Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"112532","DOI":"10.1016\/j.psychres.2019.112532","article-title":"Using formative evaluation methods to improve clinical implementation efforts: description and an example","volume":"283","author":"Elwy","year":"2020","journal-title":"Psychiatry Res"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1007\/s11606-006-0267-9","article-title":"The role of formative evaluation in implementation research and the QUERI experience","volume":"21","author":"Stetler","year":"2006","journal-title":"J Gen Intern Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"100894","DOI":"10.1016\/j.conctc.2022.100894","article-title":"Process evaluations undertaken alongside randomised controlled trials in the hospital setting: a scoping review","volume":"26","author":"Lockwood","year":"2022","journal-title":"Contemp Clin Trials Commun"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13643-019-1161-y","article-title":"Systematic review of the use of process evaluations in knowledge translation research","volume":"8","author":"Scott","year":"2019","journal-title":"Syst Rev"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13012-021-01105-3","article-title":"The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare","volume":"16","author":"Miller","year":"2021","journal-title":"Implement Sci"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1016\/j.annemergmed.2025.04.005","article-title":"Formative evaluation to inform implementation of sepsis bundles in emergency departments","volume":"86","author":"Frank","year":"2025","journal-title":"Ann Emerg Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s13012-015-0209-1","article-title":"A refined compilation of implementation strategies: results from the expert recommendations for implementing change (ERIC) project","volume":"10","author":"Powell","year":"2015","journal-title":"Implement Sci"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e124","DOI":"10.1017\/cts.2023.552","article-title":"Guidance on interim analysis methods in clinical trials","volume":"7","author":"Ciolino","year":"2023","journal-title":"J Clin Translational Sci"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"112516","DOI":"10.1016\/j.psychres.2019.112516","article-title":"Qualitative methods in implementation research: an introduction","volume":"280","author":"Hamilton","year":"2019","journal-title":"Psychiatry Res"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13012-019-0853-y","article-title":"Comparison of rapid vs in-depth qualitative analytic methods from a process evaluation of academic detailing in the veterans health administration","volume":"14","author":"Gale","year":"2019","journal-title":"Implement Sci"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1136\/bmjqs-2017-006926","article-title":"Are quality improvement collaboratives effective? A systematic review","volume":"27","author":"Wells","year":"2018","journal-title":"BMJ Qual Saf"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1007\/s11414-022-09826-z","article-title":"Learning collaboratives: a strategy for quality improvement and implementation in behavioral health","volume":"50","author":"Gotham","year":"2023","journal-title":"J Behav Health Serv Res"},{"key":"ref26","volume-title":"Implementation strategies for evidence-based practice in health and health care: A review of the evidence","author":"Hero","year":"2023"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"CD000259","DOI":"10.1002\/14651858.CD000259.pub3","article-title":"Audit and feedback: effects on professional practice and healthcare outcomes","volume":"6","author":"Ivers","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"ref28","doi-asserted-by":"crossref","DOI":"10.1001\/jamahealthforum.2023.4964","article-title":"Job flows into and out of health care before and after the COVID-19 pandemic","volume-title":"JAMA health forum","author":"Shen","year":"2024"},{"key":"ref29","volume-title":"Data brief: Health care workforce challenges threaten hospitals\u2019 ability to care for patients","year":"2021"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1186\/s12913-024-11139-0","article-title":"Application of the FRAME-IS to a multifaceted implementation strategy","volume":"24","author":"Schoenthaler","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1186\/s43058-023-00529-w","article-title":"The longitudinal implementation strategy tracking system (LISTS): feasibility, usability, and pilot testing of a novel method","volume":"4","author":"Smith","year":"2023","journal-title":"Implement Sci Commun"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1748494\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T09:56:56Z","timestamp":1771927016000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1748494\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,5]]},"references-count":31,"alternative-id":["10.3389\/fmed.2026.1748494"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1748494","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,5]]},"article-number":"1748494"}}