Rapid Admission/Discharge Process for Febrile Neutropenia

Abstract

The National Comprehensive Cancer Network (NCCN) considers blood and marrow transplant (BMT) patients intermediate to high risk when treating febrile neutropenia. NCCN and the Infectious Diseases Society of America (IDSA) guidelines recommend that high risk patients should be admitted for inpatient intravenous antibiotics and monitoring. At our institution, we currently follow the standard of care recommended in the guidelines and admit hematological malignancy patients for the treatment of febrile neutropenia which has resulted in high admission rates. The primary objective is to reduce readmission rates by a rapid admission for observation and discharge process. Patients will be discharged on oral antibiotics or home infusion within 48 hours. Upon discharge patients will follow up in clinic with their healthcare provider. The secondary objective of the study is to assess physician compliance to the newly implemented checklist. This is a quality improvement project to help decrease the admission rate for febrile neutropenia in the hematological malignancy population. The focus will be on utilizing a checklist to help facilitate a rapid admission/discharge process. The checklist is comprised of high risk features that providers should assess all patients for. If patients have 2 or more of the risk factors they should remain inpatient per current standard of care otherwise patients should be discharged within 48 hours. Hematological malignancy patients admitted from October 2017- January 31st 2019 will be reviewed and compared to historical data on readmission rates at our institution. Preliminary data has shown a decrease in the length of admission (3 vs. 5 days) between patients where the protocol was utilized versus historical data. Reasons patients have not discharged within 48 hours has included clinician judgment, positive cultures and severe neutropenia. Data collection is ongoing and updated results will be presented at the meeting in February 2019.