Using Process Improvement Tools to Improve the Care of Patients With Neutropenic Fever in the Emergency Room

The purpose of this study was to improve the care of patients with neutropenic fever in an academic acute care hospital's emergency room (ER).

Using the define, measure, analyze, improve, control method, a two-phase project with three critical to quality metrics (reduction in time to antibiotic administration, increase in percentage of patients with neutropenic fever identified as an oncology emergency, and increase in patients cohorted on oncology units) was completed. Phase I consisted of implementation of best practices (ie, use of neutropenic fever protocol and order set, altering ER workflow, and educating patients and staff). In phase II, the team drew from cardiac and stroke alerts and response teams and implemented an innovative hospital-wide overhead neutropenic fever alert and an ER neutropenic fever response team.

After implementing phase I interventions, the time to antibiotic administration decreased from a mean of 100 minutes at baseline to a mean of 67 minutes. After implementing phase II interventions, the mean decreased by 73%, from 100 minutes at baseline to 27 minutes. Furthermore, after phase II interventions, 89% of neutropenic patients were assigned an Emergency Severity Index of 2 and 88% were placed appropriately in a bed on the oncology floor on admission, compared with 11% and 74%, respectively, at baseline.

Interventions were effective at improving three critical to quality metrics. Multiple iterations of the define, measure, analyze, improve, control cycle, together with new innovative interventions, were crucial to meeting project goals.