(51) Improving First Dose Antibiotic Times for Febrile Neutropenic Oncology Patients Presenting to the Emergency Department

Title: Improving First Dose Antibiotic Times for Febrile Neutropenic Oncology Patients Presenting to the Emergency Department

Abstract : Pediatric oncology patients presenting to the emergency department (ED) with neutropenic fever were experiencing intravenous (IV) antibiotic start times greater than 60 minutes from time of triage. Between October 2022 and March 2023, the first dose of antibiotic administration took, on average, 66.74 minutes. As research suggests, oncology patients presenting to the ED with fever is a medical emergency requiring timely administration of antibiotics due to increased risk of morbidity, mortality, and increased health care costs. The recommended time for antibiotic administration is less than 60 minutes from presentation to the ED.
This quality improvement project aimed at improving timely IV antibiotic administration for febrile neutropenic pediatric oncology patients presenting to the ED.
A multidisciplinary team from the emergency, hematology/oncology (HemOnc), pharmacy, and informatic technology (IT) departments were created to assess gaps in practice, barriers, and mitigation strategies in April 2023. Multiple PDSA cycles from each department were implemented through July 2024. This included increasing clinical staff competence through education and creating a new infusaport validation process, improving prompt IV antibiotic ordering and delivery through IT and pharmacy process changes, and improving ED team communication and interdepartmental communication when patients arrive. Additionally, a new feature was created and implemented on the patient portal that enables patients to alert the ED when they are on their way.
From August 2024 to January 2025, IV antibiotic administration took, on average, 53.3 minutes from the time patients were triaged in the ED, a decrease of 13.44 minutes. The most recent documentation on a single patient was IV antibiotics started within 28 minutes of presenting to the ED. This improvement highlights the multidisciplinary collaboration across specialties which is key in managing these high-risk patients effectively. Additionally, improving timely IV antibiotic administration for this patient population is critical to improving patient outcomes.