Vedi A, Pennington V, O'Meara M, Stark K, Senner A, Hunstead P, Adnum K, Londall W, Maurice L, Wakefield Claire, Cohn R J
Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia,
Support Care Cancer. 2015 Jul;23(7):2079-87. doi: 10.1007/s00520-014-2572-x. Epub 2014 Dec 23.
Febrile neutropenia remains a common, life-threatening complication of chemotherapy in paediatric oncology. Delays in institution of empiric antibiotics have been identified at tertiary and regional centres caring for these patients and associated with decreased survival. Our objective was to reduce the time to administration of empiric antibiotics to less than 60 min from the time of presentation to hospital.
A retrospective study of the records of oncology patients presenting to the emergency department of a tertiary hospital over a 3-month period was performed and time to first antibiotic administration recorded. Potential causes of delay in commencement of antibiotics were identified and an algorithm-based approach to the management of fever in immunocompromised children developed and implemented. Follow-up evaluation data were collected at 12 and 60 months post-intervention. Causes of delay in commencement of antibiotics at regional hospitals that share care with the tertiary hospital were identified through questionnaires, interviews and focus groups, involving patients and medical and nursing staff. The impact of the introduction of the algorithm at one peripheral hospital was evaluated.
The mean time to empiric antibiotics was reduced from 148 min (95% confidence interval (CI) 81-216) at baseline to 76 min (95% CI 50-101) at 12 months post-intervention and sustained at 65 min (95% CI 52-77) 5 years after the intervention. At the peripheral hospital, mean time to antibiotic delivery was reduced from 221 min (95% CI 114-328) to 65 min (95% CI 42-87) at 12 months after the intervention.
The introduction of the guideline, with teaching and support for staff and parents, resulted in an improvement in practice, meeting international guidelines and achieving sustained results at 5 years after introduction at a tertiary hospital. The guideline has been shown to be feasible and effective at a regional hospital.
发热性中性粒细胞减少症仍是儿科肿瘤化疗常见的危及生命的并发症。在为这些患者提供治疗的三级和地区中心，已发现经验性抗生素治疗的延迟，并与生存率降低相关。我们的目标是将经验性抗生素给药时间从就诊时缩短至60分钟以内。
对一家三级医院急诊科3个月内收治的肿瘤患者记录进行回顾性研究，并记录首次使用抗生素的时间。确定抗生素开始使用延迟的潜在原因，并制定和实施基于算法的免疫功能低下儿童发热管理方法。在干预后12个月和60个月收集随访评估数据。通过问卷调查、访谈和焦点小组，对与三级医院共同提供护理的地区医院抗生素开始使用延迟的原因进行了调查，涉及患者、医护人员。评估了在一家外围医院引入该算法的影响。
经验性抗生素的平均给药时间从基线时的148分钟（95%置信区间（CI）81 - 216）降至干预后12个月时的76分钟（95%CI 50 - 101），并在干预后5年维持在65分钟（95%CI 52 - 77）。在外围医院，干预后12个月抗生素给药的平均时间从221分钟（95%CI 114 - 328）降至65分钟（95%CI 42 - 87）。
引入该指南，并对工作人员和家长进行教学与支持，使实践得到改善，符合国际指南，并在一家三级医院引入后5年取得了持续成效。该指南已被证明在地区医院是可行且有效的。
