Neutropenic fever: one institution's quality improvement project to decrease time from patient arrival to initiation of antibiotic therapy.

Neutropenic fever is an oncologic emergency that requires prompt assessment and treatment with antibiotics. Although the term "prompt" is not defined in numbers of minutes in the biomedical literature, the literature does indicate that the sooner antibiotics are initiated, the greater the likelihood of a positive clinical outcome. At Dartmouth-Hitchcock Medical Center in Lebanon, NH, the oncology team was concerned about the length of time before adult inpatients with febrile neutropenia received their initial dose of antibiotics (cycle time). The purpose of this quality improvement project was to reduce treatment delays in patients with febrile neutropenia. A multidisciplinary team charted the existing admission process and identified three areas for improvement: (a) inpatient orders, (b) the admission communication process, and (c) multidisciplinary staff accountability. Following implementation, the hematology and oncology clinical nurse specialist completed a chart review of all patients with febrile neutropenia, which revealed a nearly 50% reduction in cycle time on the inpatient unit.