title: Improving the immediate management of neutropenic sepsis in the UK: lessons from a national audit.
abstract: Recent disquiet at inadequacies in the immediate management of neutropenic sepsis in the UK led to a new, gold standard 'door-to-needle' time of 1 h for the administration of intravenous antibiotics. The aim of this audit was to identify whether that target is being met nationally, the potential barriers to its achievement, and concrete recommendations for how to overcome these. We also sought to establish the degree of regional heterogeneity in current local management protocols. Questionnaires were sent to haematologists across the UK to determine their unit's immediate management of patients presenting from the community with possible neutropenic sepsis. Local protocols and audits were also requested. Data covering 95 different hospitals were received, covering a combined catchment area of nearly 30 million people. There were marked regional inconsistencies in the definition of 'neutropenic sepsis' and almost every aspect of its immediate management. Only 26% of audited patients (n=627) received intravenous antibiotics within the target time of 1 h. Median door-to-needle times ranged from 30 min to 4 h. Long delays of over 5 h were not uncommon.
authors.affiliation: John Radcliffe Hospital, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford, UK.
authors.forename: Rachel T
authors.initials: RT
authors.lastname: Clarke
authors.forename: Janine
authors.initials: J
authors.lastname: Warnick
authors.forename: Kate
authors.initials: K
authors.lastname: Stretton
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Littlewood
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D005334:Fever / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007275:Injections, Intravenous; D008485:Medical Audit / Q000706:statistics & numerical data*; D009503:Neutropenia / Q000150:complications* / Q000175:diagnosis; D009894:Opportunistic Infections / Q000150:complications / Q000188:drug therapy*; D011364:Professional Practice / Q000592:standards / Q000706:statistics & numerical data; D058996:Quality Improvement; D018805:Sepsis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D013997:Time Factors; D006113:United Kingdom
chemical_list: D000900:Anti-Bacterial Agents