A QI Initiative to Reduce Time to Antibiotics in Oncologic Neutropenic Fever

Problem Statement Neutropenic fever (NF) (defined as temperature of 101o F on one occasion, or 100.4o F sustained over 60 minutes in a patient with an absolute neutrophil count (ANC) less than 500, or suspected drop below 500 within 48 hours) is relatively common oncologic emergency, particularly in hematologic malignancy patients. Expert consensus is that anti-pseudomonas gram-negative antibiotics (abx) should be administered within 60 minutes of detecting neutropenic fever. At Thomas Jefferson University Hospital (TJUH), internal guidelines for time to treatment in neutropenic fever are in line with expert consensus - 60 minutes. We found that from July 1st – November 21st, 2018 our median time to abx in neutropenic fever cases was 117.5 minutes. As a result we are proposing to implement a continuous process improvement initiative using PDSA (Plan-Do-Study-Act) cycles with the goal of reducing time to treatment for neutropenic fever.https://jdc.jefferson.edu/patientsafetyposters/1121/thumbnail.jp