Reducing Antibiotic Delays For Febrile Cancer Patients in the ED

Fevers in cancer patients receiving chemotherapy can indicate an infection, which may be life- threatening. Quick administration of antibiotics is critical to minimize harm, shorten hospital stays and improve patient outcomes.

With the goal of reducing antibiotic administration delays in these patients, Cleveland Clinic researchers worked with the medical center’s Emergency Department (ED) personnel to implement several changes, including:

• Standardizing the definition of fever
• Providing patients with cards alerting caregivers to the severity of febrile neutropenia (FN)
• Revising ED triage levels to elevate FN to the level of heart attack or stroke
• Standardizing the FN treatment protocol in the electronic medical record
• Ensuring immediate antibiotic availability in the ED

The researchers then studied all adult cancer patients who presented with fever at Cleveland Clinic’s ED between June 2012 and June 2013, comparing their outcomes with those of a group of cancer patients treated in the ED prior to the FN changes, and to a group of febrile cancer patients admitted directly to the hospital’s inpatient oncology service.

The investigators followed participating cancer patients for one year. Results showed that the FN protocol changes significantly decreased the time it took affected patients to receive antibiotics and shortened their hospital stays compared with the other groups.

Read an account of the research in the ASCO Post.