title: Improving the emergency department management of post-chemotherapy sepsis in haematological malignancy patients.
abstract: OBJECTIVE
  To review the result of the implementation of treatment protocol for post-chemotherapy sepsis in haematological malignancy patients.
  
  
  METHODS
  Case series with internal comparison.
  
  
  METHODS
  Accident and Emergency Department, Queen Elizabeth Hospital, Hong Kong.
  
  
  METHODS
  Febrile patients presenting to the Accident and Emergency Department with underlying haematological malignancy and receiving chemotherapy within 1 month of Accident and Emergency Department visit between June 2011 and July 2012. Similar cases between June 2010 and May 2011 served as historical referents.
  
  
  METHODS
  The compliance rate among emergency physicians, the door-to-antibiotic time before and after implementation of the protocol, and the impact of the protocol on Accident and Emergency Department and hospital service.
  
  
  RESULTS
  A total of 69 patients were enrolled in the study. Of these, 50 were managed with the treatment protocol while 19 patients were historical referents. Acute myeloid leukaemia was the most commonly encountered malignancy. Overall, 88% of the patients presented with sepsis syndrome. The mean door-to-antibiotic time of those managed with the treatment protocol was 47 minutes versus 300 minutes in the referent group. Overall, 86% of patients in the treatment group met the target door-to-antibiotic time of less than 1 hour. The mean lengths of stay in the emergency department (76 minutes vs 105 minutes) and hospital (11 days vs 15 days) were shorter in those managed with the treatment protocol versus the historical referents.
  
  
  CONCLUSIONS
  Implementation of the protocol can effectively shorten the door-to-antibiotic time to meet the international standard of care in neutropenic sepsis patients. The compliance rate was also high. We proved that effective implementation of the protocol is feasible in a busy emergency department through excellent teamwork between nurses, pharmacists, and emergency physicians.
authors.affiliation: Accident and Emergency Department, Queen Elizabeth Hospital, Jordan, Hong Kong.
authors.forename: H F
authors.initials: HF
authors.lastname: Ko
authors.affiliation: Accident and Emergency Department, Queen Elizabeth Hospital, Jordan, Hong Kong.
authors.forename: S S
authors.initials: SS
authors.lastname: Tsui
authors.affiliation: Accident and Emergency Department, Queen Elizabeth Hospital, Jordan, Hong Kong.
authors.forename: Johnson W K
authors.initials: JW
authors.lastname: Tse
authors.affiliation: Accident and Emergency Department, Queen Elizabeth Hospital, Jordan, Hong Kong.
authors.forename: W Y
authors.initials: WY
authors.lastname: Kwong
authors.affiliation: Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
authors.forename: O Y
authors.initials: OY
authors.lastname: Chan
authors.affiliation: Accident and Emergency Department, Queen Elizabeth Hospital, Jordan, Hong Kong.
authors.forename: Gordon C K
authors.initials: GC
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000150:complications*; D002985:Clinical Protocols; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019337:Hematologic Neoplasms / Q000150:complications* / Q000628:therapy; D006723:Hong Kong; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000139:chemically induced / Q000628:therapy*; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Drug therapy; Emergency service, hospital; Hematologic neoplasms; Sepsis