title: Reducing Time to Antibiotic Administration for Febrile Neutropenia in the Emergency Department.
abstract: OBJECTIVE
  Febrile neutropenia (FN) is an oncologic emergency, and prolonged time to antibiotic administration (TTA) is associated with increased hospital length of stay (LOS) and worse outcomes. We hypothesized that a febrile neutropenia pathway (FNP) quality initiative project would reduce TTA delays for febrile patients with cancer presenting to the emergency department (ED).
  
  
  METHODS
  This prospective study compared ED FNP patients (> 18 years old), between June 2012 and June 2013 with both historical and direct admissions (DA) cohorts at a multispecialty academic center. Interventions included providing patients with FN-Alert cards, standardizing the definition of FN and recognizing it as a distinct chief complaint, revising ED triage level for FN, creating electronic FN order sets, administering empiric antibiotics before neutrophil count result, and relocating FN antibiotics to the ED. The primary outcome was TTA, with a target goal of 90 minutes after ED presentation.
  
  
  RESULTS
  In total, 276 FN episodes in 223 FNP patients occurred over the 12-month study period and were compared with 107 episodes in 87 patients and 114 episodes in 101 patients in the historical and DA cohorts, respectively. Use of the FNP reduced TTA from 235 and 169 minutes in historical and DA cohorts, respectively, to 81 minutes, and from 96 to 68 minutes when the order set was not used versus used in the FNP group (P < .001 for all comparisons). Decrease in hospital LOS was not statistically significant.
  
  
  CONCLUSIONS
  The ED FNP is a significant quality initiative with sustainable interventions, and was able to demonstrate value by decreasing TTA compared to both historical and DA controls in cancer patients presenting to the ED.
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Keng
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Elaine A
authors.initials: EA
authors.lastname: Thallner
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Paul
authors.initials: P
authors.lastname: Elson
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Christine
authors.initials: C
authors.lastname: Ajon
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sekeres
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Candice M
authors.initials: CM
authors.lastname: Wenzell
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: David J
authors.initials: DJ
authors.lastname: Seastone
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Erika M
authors.initials: EM
authors.lastname: Gallagher
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Weber
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Earl
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Sudipto
authors.initials: S
authors.lastname: Mukherjee
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Brad
authors.initials: B
authors.lastname: Pohlman
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Eric
authors.initials: E
authors.lastname: Cober
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Virginia B
authors.initials: VB
authors.lastname: Foster
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Joy
authors.initials: J
authors.lastname: Yuhas
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Matt E
authors.initials: ME
authors.lastname: Kalaycio
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.affiliation: Cleveland Clinic, Cleveland, OH sekerem@ccf.org.
authors.forename: Mikkael A
authors.initials: MA
authors.lastname: Sekeres
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D064147:Febrile Neutropenia / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents