Ali Natasha, Baqir Muhammad, Hamid Aasma, Khurshid Mohammad
Hematology. 2015 Jan;20(1):26-30. doi: 10.1179/1607845414Y.0000000169. Epub 2014 Apr 12.
Recently, due to inadequacies during immediate management of patients with febrile neutropenia, a new gold standard 'door-to-needle' time of 1 hour for the administration of intravenous antibiotics was introduced.
The aim of this audit was to identify whether that target was being met in our emergency department (ED). This is phase 1 of the study which will be followed by identification of barriers to the achievement of the target and recommendations for improvement.
Data were collected from January 2013 to April 2013 of consecutive patients (adult and pediatric age group) who presented to the ED with febrile neutropenia for various underlying causes. Fever was defined as single oral temperature of >38.3°C (101°F) or a temperature of >38.0°C (100.4°F) sustained for more than 1 hour. Neutropenia was defined as absolute neutrophil count <0.5 × 10(9)/l, or expected to fall below that number. Variables analyzed included age, gender, antibiotics administered, underlying diagnosis, day of presentation, and door-to-needle time.
During the study period, there were n = 81 patients who presented with febrile neutropenia. There were n = 49 were males and n = 32 were females. There were n = 37 patients in the pediatric age group while rest were adults. Patients most commonly had an underlying hematological malignancy (n = 49). A combination of piperacillin/tazobactam (4.5 g × Q8hrly) and amikacin (750 mg × once daily) was most frequently administered (n = 57) to these patients. The median door-to-needle time was 45 minutes (range ± SD: 10 minutes to 6 hours ± 1 hour 10 minutes). Long delays of over 4 hours occurred in n = 4 patients (all were adults). There were minimal delays observed in pediatric patients due to 'red alert' policy implementation. Long delays occurred on weekdays and weekends, equally.
The overall median door-to-needle time was 45 minutes, which was in the accepted range. However, delays that occurred demand improvements like introducing 'red alert' policy for adult patients, counseling of staff and residents, identifying potential barriers in achieving the target time along with solutions, and developing hospital-based guidelines on managing patients with neutropenic sepsis.
最近，由于发热性中性粒细胞减少症患者即时处理存在不足，引入了新的静脉用抗生素给药“门到针”时间的黄金标准——1小时。
本次审核旨在确定我们急诊科（ED）是否达到该目标。这是该研究的第1阶段，随后将确定实现该目标的障碍并提出改进建议。
收集2013年1月至2013年4月因各种潜在病因到急诊科就诊的连续发热性中性粒细胞减少症患者（成人和儿童年龄组）的数据。发热定义为单次口腔温度>38.3°C（101°F）或温度>38.0°C（100.4°F）持续超过1小时。中性粒细胞减少症定义为绝对中性粒细胞计数<0.5×10⁹/l，或预计降至该数值以下。分析的变量包括年龄、性别、使用的抗生素、潜在诊断、就诊日期和门到针时间。
在研究期间，有n = 81例发热性中性粒细胞减少症患者就诊。其中n = 49例为男性，n = 32例为女性。儿科年龄组有n = 37例患者，其余为成人。患者最常见的潜在疾病是血液系统恶性肿瘤（n = 49）。这些患者最常使用哌拉西林/他唑巴坦（4.5 g×每8小时一次）和阿米卡星（750 mg×每日一次）联合用药（n = 57）。门到针时间的中位数为45分钟（范围±标准差：10分钟至6小时±1小时10分钟）。n = 4例患者（均为成人）出现超过4小时的长时间延迟。由于实施“红色预警”政策，儿科患者的延迟时间最短。工作日和周末出现长时间延迟的情况相同。
总体门到针时间中位数为45分钟，处于可接受范围内。然而，出现的延迟需要改进，如为成年患者引入“红色预警”政策、对工作人员和住院医师进行培训、确定实现目标时间的潜在障碍及解决方案，以及制定基于医院的中性粒细胞减少性脓毒症患者管理指南。
