title: A comparison of ED and direct admission care of cancer patients with febrile neutropenia.
abstract: OBJECTIVE
  We compared the quality of care in admitted febrile neutropenic cancer patients presenting through the emergency department (ED) vs those directly admitted (DA) from the clinic or infusion center. We hypothesized that the quality of care would be comparable between these 2 pathways.
  
  
  METHODS
  We conducted a retrospective, observational cohort study of all adult cancer patients hospitalized with subjective or objective fever (≥100.4°F) and documented neutropenia (absolute neutrophil count ≤1000/mm(3)) from January 1, 2011 to June 30, 2013, at 2 hospitals. Two investigators retrieved data including patient age, sex, race, tumor type, blood culture growth, temperature (actual or reported), pathway to admission (ED or DA), time to antibiotic administration, length of stay, and the Multinational Association for Supportive Care in Cancer (MASCC) risk score. The primary outcome measures were time to antibiotic administration, appropriateness of antibiotic(s) administered based on published guidelines, length of stay, and MASCC score-based risk assessment. We used the t test for the difference between 2 means with unequal population variances to compare these outcome measures between ED and DA patients.
  
  
  RESULTS
  One hundred twenty-seven visits met inclusion criteria (42 [33%] ED visits, 85 [67%] DA visits). Mean time to antibiotic administration, mean length of stay, appropriateness of antibiotics, and MASCC score-based risk assessment were comparable between ED and DA visits (P>.05 for all comparisons).
  
  
  CONCLUSIONS
  The quality of care for febrile neutropenia in patients presenting through the ED was comparable to those directly admitted to the hospital in this 2-center study.
authors.affiliation: Department of Pharmacy, Allegheny Health Network, Pittsburgh, PA.
authors.forename: Diwura K
authors.initials: DK
authors.lastname: Owolabi
authors.affiliation: Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA.
authors.forename: Richard
authors.initials: R
authors.lastname: Rowland
authors.affiliation: Department of Pharmacy, Allegheny Health Network, Pittsburgh, PA.
authors.forename: Lauren
authors.initials: L
authors.lastname: King
authors.affiliation: Department of Pharmacy, Allegheny Health Network, Pittsburgh, PA.
authors.forename: Rick
authors.initials: R
authors.lastname: Miller
authors.affiliation: Katz Graduate School of Business, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Gajanan G
authors.initials: GG
authors.lastname: Hegde
authors.affiliation: Katz Graduate School of Business, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Shang
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Allegheny Health Network, Pittsburgh, PA.
authors.forename: John
authors.initials: J
authors.lastname: Lister
authors.affiliation: Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA. Electronic address: avenkat@wpahs.org.
authors.forename: Arvind
authors.initials: A
authors.lastname: Venkat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000188:drug therapy / Q000628:therapy*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D010343:Patient Admission; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents