Care pathways can improve the emergency management of febrile neutropenia in children

Abstract

Background: Febrile neutropenia is a common oncological presentation to many paediatric emergency departments (ED). Antibiotics are ideally administered within an hour of presentation. Despite staff awareness of this, and appropriate triaging, clinical practice review at our institution in two successive audits 1 year apart revealed a median time to antibiotic administration of approximately 90min,with less than 30% of children receiving antibiotics within an hour. These findings prompted the development of a care pathway. Objectives: To assess the effects of introducing a care pathway for the initial management of febrile, potentially neutropenic, oncology patients presenting to the ED on 'time to antibiotic administration' (TTA). Methods: All febrile, potentially neutropenic, oncology patients presenting to ED over two 3month periods (commencing approximately 3 and 9months after pathway introduction) were included. Data collection was primarily prospective, with review undertaken to determine missing cases and data points. Intermittent clinical audit was undertaken during these periods with feedback and education provided. Results: All patients were aged between 0-17 years. 56 presentations occurred during the first 3month period with an overall median TTA of 59min. A progressive improvement in median TTA across the 3months occurred (69, 67 and 47 min, respectively with 40%, 39% and 78% of patients receiving antibiotics within an hour). 50 presentations occurred during the second 3month period. Median overall TTA in this cohort was 52min with 72% of patients receiving antibiotics within an hour and 88% within 90 min. Conclusion: In the setting of timely, tailored feedback and widespread departmental support, care pathways can improve the management of children with febrile neutropenia in a busy ED environment. Ongoing review will be required to assess whether improvements can be sustained, or even furthered, and whether similar results can be achieved in peripheral centres.L6116461932016-08-16 <br />