title: Assessment of Fever Advisory Cards (FACs) as an Initiative to Improve Febrile Neutropenia Management in a Regional Cancer Center Emergency Department.
abstract: We aimed to improve the time to antibiotics (TTA) for patients treated with chemotherapy who present to the emergency department (ED) with febrile neutropenia (FN) by using standardized fever advisory cards (FACs).
  
  
  
  Patients treated with chemotherapy who visited the ED at the Peel Regional Cancer Center in Ontario, Canada, with suspected FN were identified, before (April 2012 to March 2013) and after (October 2013 to March 2014) FAC implementation. The primary outcome of interest was TTA. Additional process measures included Canadian Triage and Acuity Scale score, time to physician assessment, and FAC compliance. Outcomes were analyzed with descriptive statistics and control charts to determine whether the change in primary measures were within statistical control over time.
  
  
  
  Between the pre-FAC cohort (n = 239) and post-FAC cohort (n = 69), TTA did not change significantly post-FACs (195 v 244 min, P = .09), with monthly averages demonstrating normal variation by statistical process control methodology. The introduction of FACs increased the percentage of patients with correctly assigned Canadian Triage and Acuity Scale scores (87% v 100%) but did not affect time to physician assessment. Compliance with FACs among patients was not ideal, with only 62.5% using them as intended.
  
  
  
  The distribution of FACs was associated with an improved incidence of correct FN triaging but did not demonstrate a meaningful improvement in the quality of FN management. This may be explained by FAC use among patients not being ideal. Next steps in the continued effort toward high-quality FN care include redesign of FACs, reinforcement of provider and patient education, and ED outreach.
authors.affiliation: University of Toronto School of Medicine and Trillium Health Partners Credit Valley Hospital, Mississauga, Ontario, Canada priyanka.kapil@mail.utoronto.ca.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Kapil
authors.affiliation: University of Toronto School of Medicine and Trillium Health Partners Credit Valley Hospital, Mississauga, Ontario, Canada.
authors.forename: Meghan
authors.initials: M
authors.lastname: MacMillan
authors.affiliation: University of Toronto School of Medicine and Trillium Health Partners Credit Valley Hospital, Mississauga, Ontario, Canada.
authors.forename: Maritza
authors.initials: M
authors.lastname: Carvalho
authors.affiliation: University of Toronto School of Medicine and Trillium Health Partners Credit Valley Hospital, Mississauga, Ontario, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Lymburner
authors.affiliation: University of Toronto School of Medicine and Trillium Health Partners Credit Valley Hospital, Mississauga, Ontario, Canada.
authors.forename: Ron
authors.initials: R
authors.lastname: Fung
authors.affiliation: University of Toronto School of Medicine and Trillium Health Partners Credit Valley Hospital, Mississauga, Ontario, Canada.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Almeida
authors.affiliation: University of Toronto School of Medicine and Trillium Health Partners Credit Valley Hospital, Mississauga, Ontario, Canada.
authors.forename: Laurie
authors.initials: L
authors.lastname: Van Dorn
authors.affiliation: University of Toronto School of Medicine and Trillium Health Partners Credit Valley Hospital, Mississauga, Ontario, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Enright
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D064147:Febrile Neutropenia / Q000139:chemically induced / Q000188:drug therapy*; D005260:Female; D005334:Fever / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014218:Triage / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents