Background
Febrile neutropenia is a significant cause of morbidity and mortality for cancer patients. Australian and international consensus guidelines support the use of ambulatory care strategies for the management of low risk febrile neutropenic patients which are aimed at early identification and timely investigations and treatment. We aim to evaluate the impact of the Rapid Assessment Clinic (RAC) on the care of febrile neutropenic patients compared with emergency department (ED) presentations.
Methods
Two cohorts of oncology patients known to the Capital Region Cancer Service (CRCS) were reviewed. Five hundred and forty-nine presented to RAC and 317 presented to ED between September 2013 and March 2015. Tumour characteristics, temperature at presentation, time to investigations and first antibiotic dose were recorded, as well as length of stay if admitted.
Results: 317 oncology patients attended ED over a 12 month period. Sixteen (5.0%) presented with febrile neutropenia. Median time to review, investigations and first dose of antibiotic were 9.5, 48 and 74 minutes respectively. If admitted the average LOS was 6 days. Of 549 patients who attended RAC over the 19-month period, 11 (2%) presented with febrile neutropenia. Median times to review, investigations and treatment were 6, 26 and 79 minutes respectively. Six patients (54.5%) were admitted with an average length of stay (LOS) of 5.3 days. There was a trend towards quicker review (6 vs 9.5 minutes; p = 0.37) and investigations (26 vs. 48 minutes; p = 0.05) if presenting to RAC, however the time to antibiotic therapy between cohorts was not statistically different.
Conclusions
Use of ambulatory care strategies through a RAC for management of low risk febrile neutropenic patients results in earlier review and initiation of investigations, however may not affect time to appropriate therapy but can reduce LOS significantly if admitted.