Quality Improvements in Timeliness to Antibiotics in Solid Organ Malignancy Patients Admitted with Febrile Neutropenia and Neutropenic Sepsis Through the Establishment of an Acute Medical Unit

Yang Jian Ong,1– 3 Nisha Sikotra,1,4 Janelle Prunster,1,2 Nicola Bailey,2 Jane Hadfield,2 Rosemary Smith,2 Rohen Skiba,2 Astrid Arellano,5 Eli Gabbay,1– 3,6 Timothy D Clay1,7,8 1Bendat Respiratory Research and Development Group, St John of God Healthcare, Subiaco, Western Australia, Australia; 2Department of Medical Teaching, St John of God Healthcare, Subiaco, Western Australia, Australia; 3The University of Notre Dame, Fremantle, Western Australia, Australia; 4Research Department, St John of God Healthcare, Subiaco, Western Australia, Australia; 5Department of Infectious Diseases, St John of God Healthcare, Subiaco, Western Australia, Australia; 6Department of Respiratory Medicine, St John of God Healthcare, Subiaco, Western Australia, Australia; 7Department of Medical Oncology, St John of God Healthcare, Subiaco, Western Australia, Australia; 8School of Medical and Health Sciences, Edith Cowan University Joondalup, Joondalup, Western Australia, AustraliaCorrespondence: Nisha Sikotra Tel +61 08 9382 9172Email Nisha.sikotra@sjog.org.auBackground: Febrile neutropenia (FN) is a medical emergency that requires prompt empirical antibiotic treatment. Logistical factors can hamper the timely delivery of antibiotics for patients with suspected FN.Aim: To determine our institution’s adherence to timeliness of antibiotic administration after the implementation of strategies following a previous audit.Methods: Two retrospective audits were performed. Patients were identified through hospital coding and data were extracted from medical records. Interventions following the first audit included targeted staff education; development of a “Febrile Neutropenia Box” and the establishment of an acute medical unit (AMU). Adherence to guidelines and the effect of interventions were compared.Results: Audit one: 72 admissions (January 2017–December 2017); audit two: 55 admissions (October 2018–October 2019). Median time to antibiotics and adherence to 60-minute administration target: audit one: 135 minutes (range 15– 5160; 11% adherence); audit two: 80 minutes (range 0– 2130; 45% adherence, P=< 0.001). In audit two, the admission ward was the major factor that reduced time to treatment – AMU: 43 minutes (range 0– 440; 70% adherence); oncology ward: 98 minutes (range 0– 2130; 40% adherence); other wards: 190 minutes (range 0– 750; 27% adherence) (p=0.028 for adherence).Conclusion: A gap in our routine care of FN was identified. We assessed the effects of several interventions. The most important intervention was the introduction of the AMU which allowed sufficient resources to address time critical tasks. Health institutions without an emergency department should consider similar pathways to ensure timely care for patients with FN. Auditing current practice and evaluating interventions are important.Keywords: febrile neutropenia, quality improvement, complications of cancer, clinical practice guidelines, FN