Abstract / Summary
Background: Febrile neutropenia (FN) is an oncological emergency in which delays in the administration of empiric broad-spectrum antibiotics can increase the risk of sepsis and other serious complications.Aim: This study aimed to reduce the median time from fever recognition to first-dose administration of empiric intravenous antibiotics to less than 60 minutes in adult oncology patients with FN presenting to the emergency department (ED) or inpatient department (IPD) of a tertiary oncology hospital.Methods: This single-centre quality improvement (QI) study employed a prospective Plan-Do-Study-Act (PDSA) approach over six months in the ED and inpatient oncology ward of Amrita Institute of Medical Sciences, Faridabad, India.Oncology patients with fever and neutropenia were included, with 26 patients evaluated in each cycle.The intervention bundle comprised standardization of the FN definition and care pathway, triage prioritization of suspected FN, staff education, fever-alert chart flags, rapid clinician notification, streamlined antibiotic ordering and administration, vascular access escalation planning, and improved ward-level antibiotic availability.The primary process measure was median time from fever recognition to first-dose empiric intravenous antibiotic administration; the proportion of patients receiving antibiotics within 60 minutes was also assessed.Patients with missing or erroneous antibioticadministration timestamps were excluded from these timeliness calculations but retained in the enrolled cohort used for all other measures.Results: In the baseline cycle, the median time to antibiotic administration was 57.5 minutes, with 50% of patients receiving antibiotics within 60 minutes among those with valid time records; documentation errors were present in six of 26 cases.Following implementation of the intervention bundle, the median time decreased to 39.5 minutes in Cycle 2 and 39 minutes in Cycle 3, while the proportion treated within 60 minutes improved to 83.3% and 84%, respectively.Documentation quality also improved, with incomplete or erroneous time records decreasing from six cases at baseline to two in Cycle 2 and one in Cycle 3. Conclusion: A structured, low-cost, multidisciplinary QI intervention was associated with faster and more reliable administration of empiric antibiotics in adult patients with FN.This project supports the use of PDSA-based workflow redesign, staff education, and rapid-alert systems to improve adherence to the 60minute antibiotic target in routine oncology practice.