Using process mapping to identify barriers to effective management of sepsis in a cancer hospital: lessons for successful implementation of a whole hospital pathway
© Thursky et al.; licensee BioMed Central Ltd. 2014
Published: 3 December 2014
Infection and sepsis are common problems in cancer management affecting up to 45% of patients. However, international guidelines focus on the management of neutropenic fever, and fail to address the recognition and resuscitation of patients who meet sepsis criteria. Peter MacCallum Hospital is a 100 inpatient-bed tertiary cancer hospital with hematology, medical oncology, cancer surgery and radiation oncology, as well as a medical and chemotherapy day unit, apheresis, and large ambulatory service but no emergency department. Records showed that up to 25% of all in-hospital Medical Emergency Team (MET) calls were attributable to sepsis with in-hospital mortality rates of up to 25%. We aimed to identify barriers to effective management of inpatient sepsis at Peter MacCallum Cancer Centre and to implement a hospital-wide sepsis pathway.
Identifying knowledge gaps and structural barriers using process mapping led to the successful design and implementation of a sepsis program. The figures show that despite increased rates of coded sepsis cases, mortality and ICU admission rates have not increased. Mortality of patients coded for sepsis March to October 2012 (13/56 (23.2%)) compared with those for March to October 2013 (10/121 (8.3%)).
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