Clinical pathways in the emergency department: Successful implementation of ‘Adult Patients who are Febrile Following Chemotherapy’ pathway

Clinical practice guidelines for children with cancer presenting with fever to the emergency room

“…We speculated that the laboratory process took more than half of the designated time. This process has been shown to be a time‐consuming step in the management of FN patients at the ER because of the requirement for multiple procedures, including obtaining the blood, sample delivery, blood analysis, and reporting of the result 8,9 . The laboratory process time may be shortened by using a rapid pathway for FN patients instead of the regular pathway.…”

“…A retrospective study of management of adult patients with FN at the ER showed that the average door‐to‐antibiotic time is 170 min 8 . The most time‐consuming part of a patient's stay in the ER is the diagnostic work‐up 8,9 . Quality improvement was implemented at Riley Hospital for Children to reduce the door‐to‐antibiotic time to <30 min for children presenting with FN 10 .…”

“…8 The most time-consuming part of a patient's stay in the ER is the diagnostic work-up. 8,9 Quality improvement was implemented at Riley Hospital for Children to reduce the door-to-antibiotic time to <30 min for children presenting with FN. 10 After the clinical guidelines were implemented, no patients were admitted to the intensive care unit (ICU) because of septic shock.…”

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

“…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%).…”

“…For length of hospital stay (LOS), five studies [24,25,27,29,33] did not find a significant difference before and after the intervention. In one of those studies [24], LOS was reduced after an intervention when compared with a historical cohort in a multivariable analysis that adjusted for age, disease type, MASCC risk index, prophylactic antibiotics, central line, and ANC, but not in univariate analysis.…”