Reducing Time-to-Antibiotics in Pediatric Oncology Patients Presenting to the Emergency Department with Fever

Febrile neutropenia is a life-threatening oncologic emergency as it increases patient risk of serious illness and may mask symptoms of infection including sepsis. Time-to-antibiotics (TTA) is a commonly used measure to set the standard of care for pediatric cancer patients at risk of septic shock with a goal of less than 60 minutes. In order to improve TTA, this quality improvement initiative within Cook Children's Medical Center (CCMC) emergency department (ED) included two interventions: education of ED providers on sepsis protocols and a best practice advisory (BPA) through the electronic medical record system, Epic, which notifies the attending physician of oncology patients presenting with fever and prompts the physician to begin the order for antibiotics. Pediatric oncology patients presenting to CCMC ED with fever and neutropenia between 4/1/2020 and 2/28/2021 were retrospectively examined. Three groups were compared in TTA: baseline (4/1/2020-7/21/2020), intervention #1 (education; 7/22/2020-10/4/2020), and intervention #2 (BPA; 10/5/2020-2/28/2021). The groups were compared using analysis of variance with a Bonferroni correction for multiple comparisons. The average TTA significantly decreased from 98.75 minutes in baseline to 69.12 minutes in intervention #2 (p< 0.01). . The months of October 2020 and February 2021 reached the goal of TTA < 60 minutes with average times of 57.5 minutes and 58.14 minutes, respectively. The combination of education and BPA interventions effectively reduced TTA for febrile neutropenic patients in the ED.