Outpatient infusion sepsis protocol and outcomes for patients with cancer.

Abstract

11135 Background: Sepsis, a life-threatening organ dysfunction caused by infection, is a common oncologic emergency in adult cancer patients. Early sepsis detection and timely antibiotic administration can improve outcomes and reduce mortality. As more oncology treatments move to outpatient infusion centers, implementing sepsis screening in these settings can improve early detection and opportunity for intervention. As a result, we implemented a best practice alert (BPA) and protocol for the initial evaluation and managements of sepsis in an outpatient oncology infusion center. Methods: We performed a retrospective study from June 2022 – December 2024 comparing outcomes of patients who presented to the outpatient oncology infusion center at our institution pre- and post-implementation of our sepsis workflow. We collected the following data: BPA alerts that were activated, time to antibiotics, initial lactate drawn, repeat lactate draw, cultures collected prior to antibiotic administration, appropriate IV fluid (IVF) resuscitation, number of patients transferred to the emergency department (ED) vs. Direct Admission (DA), length of stay, and number of Intensive Care Unit (ICU) transfers. Results: Pre-implementation (June – December 2022), 102 oncology patients were admitted with sepsis from the infusion center. Average time to antibiotics was 6 hours (SD=6.95), 90% had blood cultures drawn prior to antibiotic administration, 85% had lactate drawn, 80% second lactate was drawn when initial lactate was >2, and 46% had appropriate IVF. Twenty-two percent were DA. Average LOS was 11 days (SD=9.18) and 14 patients required ICU stay. Post-implementation (June 2023 – June 2024), 118 patients were evaluated and treated for possible sepsis. Average time to antibiotics was 1.5 hours, 100% had blood cultures prior to antibiotics, 95% had initial lactate, 91% had second lactate drawn if initial was >2, 46% appropriate IVF. Thirty four percent of evaluated patients were managed as an outpatient. Of those admitted, 78% were DA. The average LOS was 6 days (SD=4.6), and 4 patients required ICU stay. Conclusions: The outpatient sepsis protocol improved early management and treatment of patients with suspected sepsis, also improving clinical outcomes. As a result of the new workflow, more patients were directly admitted to the hospital avoiding unnecessary ED utilization. Early management helped reduce severity of sepsis resulting in fewer ICU admissions and shorter length of stay in the hospital. These improvements demonstrate the protocol's effectiveness and potential for broader application in oncology settings. Additional evaluation is needed to determine the generalizability of the protocol as it is scaled across the health system.