Neutropenic fever (NF) is an oncologic emergency for which expert consensus recommends that anti-pseudomonas antibiotics be administered within 60 minutes of detection. This study investigated whether delays in time to antibiotics (TTA) impacted overall survival (OS) for patients with hematological malignancies who developed inpatient NF via a retrospective cohort study of 187 de novo NF cases categorized by TTA (<1, 1–2, 2–3, 3–4 and >4 hours). OS at 180 days post-NF episode was compared using Kaplan-Meier estimates and multivariable Cox proportional hazards model. TTA did not significantly affect OS (P = 0.420). Patients with Charleston Comorbidity Indexes ≥3, a measure of overall health, had higher hazard (hazard ratio [HR] = 2.728, 95% confidence interval, 1.265-5.882, P = 0.010). TTA delays in the hospital may not be long enough to cause significant patient harm. Larger studies may be needed to detect small, but significant mortality differences.

310 Background: Timely administration of antibiotics in patients with neutropenic fever (NF) is essential for reducing morbidity and mortality among oncology patients. Due to their immunocompromised state, neutropenic patients are at particularly high risk of developing severe complications from infection. The optimal time to antibiotics (TTA) for patients with NF is unclear, but IDSA/ASCO guidelines recommend a median TTA within one hour of documented fever. This study focused on identifying barriers at a single academic institution to timely antibiotic administration for patients admitted to the inpatient Bone Marrow Transplant (BMT) unit, and implemented new processes to reduce median TTA to less than 60 minutes. Methods: Patients who developed NF during their hospital admission were included in the study. Individuals who were transferred from another facility or presented to the Emergency Department with NF were excluded. Chart reviews were performed to identify root causes for delays in antibiotics (abx). Data was collected for the following time points: time from fever to notification of provider, time from notification to abx order, time from order to release, and time from release to administration. The research team also met with key stakeholders from nursing, pharmacy, advance practice providers, and physicians to better understand the process. Results: Based on the root cause analysis, 4 interventions were implemented: cefepime was stocked in the pyxis (Int 1 – August 2018), NF guidelines were updated (Int 2 – October 2019), Educational videos were created for just in time learning for house staff rotating on the oncology services and an education campaign for the nursing staff (Int 3 – June 2020), a nurse driven protocol to release and administer abx was piloted on the BMT (Int 4 – December 2021). Baseline TTA was 128 minutes. After Int 1, median TTA decreased to 77.2 minutes. Int 2 and Int 3 did not improve median TTA. In October 2020, median TTA had increased to 98 minutes. After Int-4, on the BMT unit, median TTA decreased to 40 minutes. Conclusions: Through iterative changes and process improvement methodology, we were able to improve our median TTA from 128 minutes to 40 minutes. The most impactful changes “simplified the process” to administer abx. Educational initiatives were less impactful, which is consistent with human factor re-engineering science and change management strategies. This improvement initiative spanned over an extended time period largely because of interruptions due to the COVID pandemic. As a result, the project demonstrated that the goal to implementing and sustaining change requires workflow redesign, culture shifts, and engagement by all key stakeholders.

e18765 Background: Neutropenic fever (NF) is relatively common oncologic emergency. Present expert consensus is that anti-pseudomonas gram-negative antibiotics should be administered within 60 minutes of detecting NF. To date studies investigating this relationship in neutropenic fever patients have been either limited in size, or have failed to reliably establish a relationship between time to antibiotics (TTA) and clinical outcomes.While some studies have shown an association between TTA and outcomes in NF patients admitted from the Emergency Department, such studies do not control for the time that patients may have been febrile in the community. To address these factors, we conducted a retrospective study on the effect of TTA on mortality in oncologic patients who developed NF as inpatients. Methods: We performed retrospective chart review of all cases of NF at an NCI designated Cancer Center between 7/1/2016 and 3/27/2019. NF was defined as temperature of 101˚ F on one occasion, or 100.4˚ F sustained over 60 minutes, with an absolute neutrophil count (ANC) less than 500. TTA and survival were calculated via chart abstraction; patients lost to follow up within 180 days were censored to the 180-day mortality group. Relationship between TTA and overall survival (OS) was analyzed via multivariable Cox regression. We excluded patients that had non-cancer related NF, were transferred from another institution with NF, were admitted from the ED with NF, or transitioned to hospice. Only the first instance of NF in any admission was analyzed. Results: A total of 187 eligible cases were identified during the study period, mean age was 57.6 +/- 13.6, 100 (53.5%) cases were in males, 114 (61.0%) cases in Caucasians, 53 (28.3%) in Black People. The 3 most common disease subtypes were acute leukemia (42.8%), plasma cell dyscrasias (27.8%), and lymphoma (16.6%). TTA showed no significant correlation with OS at any timeframe studied. Low Charlson Comorbidity Index ( < 3) correlated with increased survival through ̃360 days, however the effect was non-significant at longer timeframes. Immediate antibiotic treatment ( < 40 mins) correlated with poorer patient prognosis and significantly decreased OS (HR 3.08;CI: 1.30-7.28; p 0.010). Conclusions: TTA was not associated with OS in our study. For inpatients with NF, even hours long TTA may not be long enough to result in adverse clinical outcomes. Unlike NF patients presenting to the ED, where true TTA may often be many hours or even days prior to arrival, a few hours-long TTA in the hospital may not be sufficiently long enough to cause significant patient harm. Interestingly, in our cohort, those who received antibiotics quickly had adverse outcomes. It may be that in patients who were clinically unstable, TTA was shorter given the urgency of the situation. Ultimately, this study’s findings question the applicability of the 60-minute guideline when used in the inpatient setting.