Abstract | BACKGROUND:
Fever in the setting of neutropenia is a potentially life-threatening complication of cancer treatment. A time of less than 60 minutes from presentation to antibiotic administration is therefore recommended. OBJECTIVE: METHODS: Lean Six Sigma is a quality improvement method that engages all impacted stakeholders and focuses on streamlining the process by removing process wastes. Stakeholders identified multiple process wastes in an in-depth study of 49 fever episodes in patients attending a tertiary care pediatric hospital, including patients waiting to be registered, waiting for laboratory technicians, delay in accessing central venous access device, waiting for absolute neutrophil count, and delayed antibiotics orders. We implemented multiple solutions: engaging patients in the process through predischarge tours of the emergency department, home application of topical anesthetic, nurse-initiated pathway, early access of central venous access device for all blood work, and planned antibiotic administration no later than 45 minutes after triage. We prospectively determined the impact of these interventions on TTA. RESULTS: The TTA significantly improved to a median of 59 minutes (interquartile range, 38.5-77.5 minutes) compared with the baseline of 99 minutes (interquartile range, 72.0-132.0 minutes; P < 0.0001). CONCLUSIONS: Lean methodology effectively identifies barriers and provides solutions to remove barriers and improve administration of antibiotics in febrile oncology patients. These can be widely applied, including in smaller institutions with minimal increased utilization of resources.
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Authors | Ashley V Geerlinks, Carol Digout, Mark Bernstein, Andrew Chan, Shannon MacPhee, Chantale Pambrun, Gloria Gallant, Lois Wyatt, Conrad V Fernandez, Victoria E Price |
Journal | Pediatric emergency care
(Pediatr Emerg Care)
Vol. 36
Issue 11
Pg. 509-514
(Nov 2020)
ISSN: 1535-1815 [Electronic] United States |
PMID | 33125202
(Publication Type: Journal Article)
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Chemical References |
- Anti-Bacterial Agents
- Antineoplastic Agents
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Topics |
- Anti-Bacterial Agents
(therapeutic use)
- Antineoplastic Agents
(adverse effects)
- Child
- Child, Preschool
- Febrile Neutropenia
(chemically induced, drug therapy)
- Historically Controlled Study
- Humans
- Neoplasms
(complications, drug therapy)
- Prospective Studies
- Time-to-Treatment
- Total Quality Management
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