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Process Analysis of Time to Antibiotics in Pediatric Patients With Fever in Neutropenia During Chemotherapy for
Christa Koenig1, Claudia E Kuehni2, Nicole Bodmer3
1Departments of Pediatrics, Pediatric Hematology and Oncology.
Insights
Timely antibiotics for children with fever and neutropenia (FN) are crucial. Delays often occur before hospital arrival and during treatment decisions, impacting care.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Healthcare Management
Background:
- Prompt antibiotic administration is vital for managing fever in neutropenia (FN) during pediatric cancer chemotherapy.
- Understanding time delays in the FN treatment pathway is essential for optimizing patient outcomes.
Purpose of the Study:
- To analyze time to antibiotics (TTA) and identify delays in FN management for children undergoing chemotherapy.
- To determine factors influencing TTA and assess the impact of process step order on treatment timeliness.
Main Methods:
- Prospective analysis of 349 FN episodes in 155 Swiss pediatric cancer patients (April 2016 - August 2018).
- Detailed examination of sub-timespans from fever detection to antibiotic initiation, comparing outpatient and inpatient settings.
Main Results:
- Median TTA was 165 minutes for outpatients and 75 minutes for inpatients.
- Significant delays observed in pre-hospital arrival (phone call to arrival: 75 min) and post-arrival decision-making (arrival to treatment decision: 60 min).
- Shorter TTA associated with pre-existing blood counts, pre-arrival treatment decisions, and office hour arrivals.
Conclusions:
- The pre-hospitalization phase significantly impacts TTA and warrants optimization strategies.
- Interventions like improved transportation, pre-arrival preparations, and regular blood counts can reduce TTA for FN patients.
Abstract:
For fever in neutropenia (FN) during chemotherapy timely start of antibiotics is recommended. We analyzed time to antibiotics (TTA) and sub-timespans between detection of fever and start of antibiotics in children undergoing chemotherapy for cancer with FN. Specifically, we aimed to assess where delays occur, which variables influence TTA, and whether the order of certain process steps affects TTA. We analyzed 349 FN episodes reported prospectively in 155 Swiss patients from April 2016 to August 2018. In outpatients, the median TTA from fever to the start of antibiotics was 165 minutes, and the median duration from fever to hospital arrival was 80 minutes. For inpatients, the median TTA from fever to the start of antibiotics was 75 minutes. The longest delays were identified for the timespans from phone call to arrival (median, 75 min) and from arrival to decision on treatment (60 min). Known blood counts at recognition of fever, decision to treat FN before arrival at the emergency department, and arrival during office hours contributed to shorter TTA. In conclusion, the time before arrival is relevant and should be considered when optimizing TTA and evaluating its influence on outcomes. Support for transportation, using time to arrive for preparations, and regular blood counts could reduce TTA.
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