Prospective Study Of An Emergency Department Febrile Neutropenia Pathway In Patients With Hematologic Malignancies
| Autor: | Matt Kalaycio, Candice M. Wenzell, Joy Yuhas, Erika M. Gallagher, Marc Earl, Michael K. Keng, David J. Seastone, Brad Pohlman, Elaine Thallner, Sudipto Mukherjee, Virginia B. Foster, Eric Cober, Mikkael A. Sekeres, Brian J. Bolwell, Christine Zayac, Paul Elson, Jennifer Sekeres, Catherine Weber, Beth Rodgers |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry Immunology Cell Biology Hematology Emergency department Neutropenia medicine.disease Biochemistry Surgery Emergency Severity Index Internal medicine medicine Absolute neutrophil count Blood culture Antibiotic prophylaxis business Prospective cohort study Febrile neutropenia |
| Zdroj: | Blood. 122:556-556 |
| ISSN: | 1528-0020 0006-4971 |
| Popis: | Background Febrile neutropenia (FN) is an oncologic emergency associated with high morbidity and mortality, particularly in patients (pts) with hematologic malignancies. Delays in antibiotic administration, which can occur in busy emergency departments (EDs), lead to worse outcomes. We instituted a FN pathway (FNP) in the Cleveland Clinic (CC) ED to reduce antibiotic delays. Methods This prospective study comparing patients from 06/12 - 06/13 to historical pts from 02/10 - 05/12, represented a collaboration among cancer center, ED, infectious disease, pharmacy, and electronic medical record representatives. Fever was defined as temperature >38°C either at home or in the ED, while neutropenia as absolute neutrophil count Results In total, 137 consecutive FN episodes in 115 pts with hematologic malignancies occurred during the 12 month study period, 63 episodes in 44 pts in the historical cohort. All pts were triaged and treated using the ED FNP, but use of the specific FN order set was variable: episodes were thus classified as treated per the order set (n=53) or not (n=84 – pts still received antibiotics, but not necessarily per the order set). Overall 60% of pts (n=89) were male and the median age at the time of first ED encounter was 59 years (range 20-88). Cancers were: non-Hodgkin lymphoma (38%), acute myeloid leukemia (21%), other leukemias (15%), and myelodysplastic syndromes (8%). Compared to historical pts, FNP study pts had a higher median ANC (2.0 vs. 0.2, p Comparing the two FNP groups treated or not treated per the order set, those treated using the order set had shorter times to antibiotics being ordered (median 28.0 vs. 60.5 minutes, p0.28). Conclusion The FNP significantly decreased time from ED registration to all set time-points, including time to antibiotics by almost three-fold, compared to historical controls in pts with hematologic malignancies. Rate of hospitalization was significantly lower, and ICU and length of stay numerically lower. The FNP is an effective clinical tool to provide prompt antibiotic administration to FN pts and likely represents a significant mechanism for improved outcomes and cost-savings to patients with hematologic malignancies presenting with FN. Disclosures: No relevant conflicts of interest to declare. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|