Background: St John of God Hospital Subiaco is a major provider of oncology services in WA. Febrile neutropenia is an oncologic emergency with the potential for significant morbidity and mortality for patients receiving cytotoxic chemotherapy. National guidelines recommend that patients presenting with suspected febrile neutropenia receive appropriate intravenous antibiotics within 60 mins of admission. Early appreciation of suspected febrile neutropenia and administration of appropriate intravenous antibiotics remains critical to preventing sepsis related complications. We aimed to review the management of patients in our institution.
Method: A retrospective review was undertaken of all patients admitted to St John of God Hospital, Subiaco in the 2017 with a known solid organ malignancy and coded as having febrile neutropenia during their admission.
Results: Medical records for 88 patients meeting inclusion criteria were reviewed. Nine patients had more than one admission. The average age of patients admitted was 64 years (23-85 years). 65% of patients were female. 73% of admissions were directly from home. Only 10% of admissions were patients given antibiotics within 60 mins. The majority of admissions patients appropriately received Tazocin (45%) or Cefepime (42%). The average length of stay of patients during the admissions was 7 days (2-41 days) with majority of patients discharged home. Within our cohort there was an 8% in-hospital mortality rate.
Patients in our centre received appropriate antimicrobial therapy in most instances. Unexpectedly we found that the administration of antibiotics was not performed in a timely manner despite the availability of a hospital protocol and national guidelines. We have identified potential barriers (including the lack of a single access point to the hospital) that we are addressing. The findings of this study should serve to remind clinicians in similar facilities of the need to audit practice around febrile neutropenia and address barriers to appropriate care.