Improving hospital performance in the treatment of febrile neutropenia

Meisenberg, Barry; Clemons, Jan; Ness, John; Faust, Nancy; Clance, Mary

doi:10.1007/s00520-014-2377-y

Cited by 13 publications

(6 citation statements)

References 13 publications

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“… 49 , 51 FN management can also be improved through the design and implementation of more efficient processes, to overcome barriers preventing the timely administration of antibiotics. 1 , 52 , 53 …”

Section: Discussionmentioning

confidence: 99%

Chemotherapy-Induced Neutropenia and Febrile Neutropenia in the US: A Beast of Burden That Needs to Be Tamed?

et al. 2022

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Neutropenia and febrile neutropenia (FN) are common complications of myelosuppressive chemotherapy. This review provides an up-to-date assessment of the patient and cost burden of chemotherapy-induced neutropenia/FN in the US, and summarizes recommendations for FN prophylaxis, including the interim guidance that was recommended during the coronavirus disease 2019 (COVID-19) pandemic. This review indicates that neutropenia/FN place a significant burden on patients in terms of hospitalizations and mortality. Most patients with neutropenia/FN presenting to the emergency department will be hospitalized, with an average length of stay of 6, 8, and 10 days for elderly, pediatric, and adult patients, respectively. Reported in-hospital mortality rates for neutropenia/FN range from 0.4% to 3.0% for pediatric patients with cancer, 2.6% to 7.0% for adults with solid tumors, and 7.4% for adults with hematologic malignancies. Neutropenia/FN also place a significant cost burden on US healthcare systems, with average costs per neutropenia/FN hospitalization estimated to be up to $40 000 for adult patients and $65 000 for pediatric patients. Evidence-based guidelines recommend prophylactic granulocyte colony-stimulating factors (G-CSFs), which have been shown to reduce FN incidence while improving chemotherapy dose delivery. Availability of biosimilars may improve costs of care. Efforts to decrease hospitalizations by optimizing outpatient care could reduce the burden of neutropenia/FN; this was particularly pertinent during the COVID-19 pandemic since avoidance of hospitalization was needed to reduce exposure to the virus, and resulted in the adaptation of recommendations to prevent FN, which expanded the indications for G-CSF and/or lowered the threshold of use to >10% risk of FN.

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Section: Discussionmentioning

confidence: 99%

Chemotherapy-Induced Neutropenia and Febrile Neutropenia in the US: A Beast of Burden That Needs to Be Tamed?

et al. 2022

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“…Meisenberg et al showed the longest delayed treatment were a consequence of the conscious or functional decision to pause the delivery of antibiotics while awaiting transfer to an inpatient unit. This delayed treatment is a result of lack of appreciation for the pathophysiology of infection and potential sepsis (11).…”

Section: Discussionmentioning

confidence: 99%

The Role of Febrile Neutropenia Guideline’s Implementation on Mortality Rate in Dharmais Hospital-National Cancer Center

Ranuhardy

2019

Indonesian Journal of Cancer

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Introduction: Febrile neutropenia have a high morbidity and mortality impact for the patient. The mortality rate of febrile neutropenia in 2002 was 38.8%, while it was 27.3% in 2009. The difference in mortality rates could be caused by several factors such as availability of the Neutropenic Fever Management Guidelines in 2006, in addition to infrastructure, human resources and equipment. This study aims to determine the role of guideline availibility and other factors to cancer mortality rate in the immunocompromised isolation room of Dharmais Hospital. Methods: This study was a cross-sectional retrospective study which investigate mortality rates and compare with adherence to febrile neutropenia guidelines for the period 2008-2012. Data were taken from the patient's medical record file, and then analysed using univariate and bivariate analysis. Results: The mortality rate in the period 2008-2012 was 20.7%. The correlation between age, sex, and degree of risk factor on mortality was not significantly different (p=0,409, p=0,404, and p=0,324). The proportion of deaths was higher in patients borne by third parties (26.8%) than in the case of personal (10%) although not statistically significant (p=0,065). From the three types of adherence, only one had a significant effect of adherence to treatment flow (p=0,033). Conclusions: The availibility of management guideline can reduce mortality rate of febrile neutropenia even though from the three types of adherence, only one had a significant effect of adherence to treatment flow (p=0,033).

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“…1. Thirty studies were included, thirteen in adult [12,[20][21][22][23][24][25][26][27][28][29][30][31], and seventeen in pediatric patients [16,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47], including a total of 1891 and 6820 FN episodes, respectively. Two-third of the studies were undertaken in the USA (n = 20; 67%).…”

Section: Overviewmentioning

confidence: 99%

Interventions aiming to reduce time to antibiotics (TTA) in patients with fever and neutropenia during chemotherapy for cancer (FN), a systematic review

Koenig

Schneider

Morgan

et al. 2019

Support Care Cancer

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Purpose Multiple interventions have been developed aiming to reduce time to antibiotics (TTA) in patients with fever and neutropenia (FN) following chemotherapy for cancer. We evaluated their effect to reduce TTA and their impact on important clinical outcomes in a systematic review. Methods The search covered seven databases. Biases and quality of studies were assessed with the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool. Interventions could be implemented in any setting and performed by any person included in the FN management. Absolute change of TTA was the primary outcome. Registration: PROSPERO (CRD42018092948). Results Six thousand two hundred ninety-six titles and abstracts were screened, 177 studies were retrieved and 30 studies were included. Risk of bias was moderate to serious in 28 studies and low in two studies. All but one study reported a reduction of TTA after the intervention. Various types of interventions were implemented; they most commonly aimed at professionals. Most of the studies made more than one single intervention. Conclusion This review may help centers to identify their specific sources of delay and barriers to change and to define what intervention may be the best to apply. This review supports the assertion that TTA can be considered a measure of quality of care, emphasizes the importance of education and training, and describes the very different interventions which have effectively reduced TTA.

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Improving hospital performance in the treatment of febrile neutropenia

Abstract: Improvements in the management of FN can be accomplished and sustained by the focused study of performance of individual tasks, the design of streamlined processes by practitioners, and the ongoing review of performance with feedback to clinical departments.

Cited by 13 publications

References 13 publications

Chemotherapy-Induced Neutropenia and Febrile Neutropenia in the US: A Beast of Burden That Needs to Be Tamed?

Chemotherapy-Induced Neutropenia and Febrile Neutropenia in the US: A Beast of Burden That Needs to Be Tamed?

The Role of Febrile Neutropenia Guideline’s Implementation on Mortality Rate in Dharmais Hospital-National Cancer Center

Interventions aiming to reduce time to antibiotics (TTA) in patients with fever and neutropenia during chemotherapy for cancer (FN), a systematic review

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