Gabrielle M Haeusler1,2,3,4,5,6, Lynda Gaynor7,8, Benjamin Teh9,10,11, Franz E Babl12,13, Lisa M Orme14, Ahuva Segal15, Francoise Mechinaud16, Penelope A Bryant17,12,8,15, Bob Phillips18, Richard De Abreu Lourenco19, Monica A Slavin9,10,11,20,21, Karin A Thursky9,10,11,20,21,22. 1. Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. gabrielle.haeusler@petermac.org. 2. University of Melbourne, Parkville, Victoria, Australia. gabrielle.haeusler@petermac.org. 3. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia. gabrielle.haeusler@petermac.org. 4. The Paediatric Integrated Cancer Service, Parkville, Victoria, Australia. gabrielle.haeusler@petermac.org. 5. Infection Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia. gabrielle.haeusler@petermac.org. 6. Murdoch Children's Research Institute, Parkville, Victoria, Australia. gabrielle.haeusler@petermac.org. 7. The Paediatric Integrated Cancer Service, Parkville, Victoria, Australia. 8. Hospital In The Home Department, Royal Children's Hospital, Parkville, Victoria, Australia. 9. Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. 10. University of Melbourne, Parkville, Victoria, Australia. 11. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia. 12. Murdoch Children's Research Institute, Parkville, Victoria, Australia. 13. Department of Emergency Medicine, Royal Children's Hospital, Parkville, Victoria, Australia. 14. Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia. 15. Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia. 16. Unité d'hématologie immunologie pédiatrique, Hopital Robert Debré, APHP Nord Université de Paris, Paris, France. 17. Infection Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia. 18. Centre for Reviews and Dissemination, University of York, York, UK. 19. Centre for Health Economics Research and Evaluation, University of Technology Sydney, New South Wales, Australia. 20. Department of Medicine, University of Melbourne, Parkville, Victoria, 3010, Australia. 21. Victorian Infectious Diseases Service, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia. 22. NHMRC National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Home-based management of low-risk febrile neutropenia (FN) is safe, improves quality of life and reduces healthcare expenditure. A formal low-risk paediatric program has not been implemented in Australia. We aimed to describe the implementation process and evaluate the clinical impact. METHOD: This prospective study incorporated three phases: implementation, intervention and evaluation. A low-risk FN implementation toolkit was developed, including a care-pathway, patient information, home-based assessment and educational resources. The program had executive-level endorsement, a multidisciplinary committee and a nurse specialist. Children with cancer and low-risk FN were eligible to be transferred home with a nurse visiting daily after an overnight period of observation for intravenous antibiotics. Low-risk patients were identified using a validated decision rule, and suitability for home-based care was determined using disease, chemotherapy and patient-level criteria. Plan-Do-Study-Act methodology was used to evaluate clinical impact and safety. RESULTS: Over 18 months, 292 children with FN were screened: 132 (45%) were low-risk and 63 (22%) were transferred to home-based care. Compared with pre-implementation there was a significant reduction in in-hospital median LOS (4.0 to 1.5 days, p < 0.001) and 291 in-hospital bed days were saved. Eight (13%) patients needed readmission and there were no adverse outcomes. A key barrier was timely screening of all patients and program improvements, including utilising the electronic medical record for patient identification, are planned. CONCLUSION: This program significantly reduces in-hospital LOS for children with low-risk FN. Ongoing evaluation will inform sustainability, identify areas for improvement and support national scale-up of the program.
BACKGROUND: Home-based management of low-risk febrile neutropenia (FN) is safe, improves quality of life and reduces healthcare expenditure. A formal low-risk paediatric program has not been implemented in Australia. We aimed to describe the implementation process and evaluate the clinical impact. METHOD: This prospective study incorporated three phases: implementation, intervention and evaluation. A low-risk FN implementation toolkit was developed, including a care-pathway, patient information, home-based assessment and educational resources. The program had executive-level endorsement, a multidisciplinary committee and a nurse specialist. Children with cancer and low-risk FN were eligible to be transferred home with a nurse visiting daily after an overnight period of observation for intravenous antibiotics. Low-risk patients were identified using a validated decision rule, and suitability for home-based care was determined using disease, chemotherapy and patient-level criteria. Plan-Do-Study-Act methodology was used to evaluate clinical impact and safety. RESULTS: Over 18 months, 292 children with FN were screened: 132 (45%) were low-risk and 63 (22%) were transferred to home-based care. Compared with pre-implementation there was a significant reduction in in-hospital median LOS (4.0 to 1.5 days, p < 0.001) and 291 in-hospital bed days were saved. Eight (13%) patients needed readmission and there were no adverse outcomes. A key barrier was timely screening of all patients and program improvements, including utilising the electronic medical record for patient identification, are planned. CONCLUSION: This program significantly reduces in-hospital LOS for children with low-risk FN. Ongoing evaluation will inform sustainability, identify areas for improvement and support national scale-up of the program.
Authors: Gabrielle M Haeusler; Alexandra L Garnham; Connie Sn Li-Wai-Suen; Julia E Clark; Franz E Babl; Zoe Allaway; Monica A Slavin; Francoise Mechinaud; Gordon K Smyth; Bob Phillips; Karin A Thursky; Marc Pellegrini; Marcel Doerflinger Journal: Clin Transl Immunology Date: 2022-05-17
Authors: Gabrielle M Haeusler; Richard De Abreu Lourenco; Cindy Bakos; Tracey O'Brien; Monica A Slavin; Julia E Clark; Brendan McMullan; Meredith L Borland; Franz E Babl; Meinir Krishnasamy; Marijana Vanevski; Karin A Thursky; Lisa Hall Journal: J Paediatr Child Health Date: 2021-02-03 Impact factor: 1.929
Authors: Anna Crothers; Gabrielle M Haeusler; Monica A Slavin; Franz E Babl; Francoise Mechinaud; Robert Phillips; Heather Tapp; Bhavna Padhye; David Zeigler; Julia Clark; Thomas Walwyn; Leanne Super; Frank Alvaro; Karin Thursky; Richard De Abreu Lourenco Journal: EClinicalMedicine Date: 2021-08-20
Authors: Marcel Doerflinger; Gabrielle M Haeusler; Connie S N Li-Wai-Suen; Julia E Clark; Monica Slavin; Franz E Babl; Zoe Allaway; Francoise Mechinaud; Gordon K Smyth; Richard De Abreu Lourenco; Bob Phillips; Marc Pellegrini; Karin A Thursky Journal: Front Immunol Date: 2021-05-20 Impact factor: 7.561