Factorial vignettes describe suspected early onset sepsis practice variation in a multicenter NICU antibiotic stewardship collaborative.

Objective: To describe provider practice preferences for term infants with suspected early-onset sepsis and preference change over time during a multicenter antibiotic stewardship collaborative.

Study design: Factorial case vignette surveys conducted at baseline of a quality improvement collaborative, and follow up after the 12 month collaborative intervention.

Results: Baseline and follow up surveys were completed by 252 (72%) and 195 (55%) respondents, respectively. The results describe both areas of compliance and non-compliance with national guidelines. There was a reduction in likelihood of ordering laboratory testing between surveys (p values ranging <0.001-0.033). A stewardship score was calculated and the mean score moved towards more stewardship friendly practices (0.39 vs 0.30).

Conclusion: We identified specific antibiotic use practice variations as potential targets for improving clinician prescribing practice in the NICU setting. Respondents moved towards more antibiotic stewardship friendly practices from baseline to the follow up survey. Vignettes methods may help optimize quality improvement.