Assessing the Impact of ED Triage Directives on Febrile Oncology Patient Wait Times

Fever during chemotherapy is a common and potentially severe complication being increasingly evaluated in emergency departments to minimize morbidity and mortality. Streamlining triage of these patients may improve health outcomes and wait times in the health care system. A retrospective chart revie...

Full description

Saved in:

Bibliographic Details
Published in:	Journal of emergency nursing Vol. 46; no. 2; pp. 254 - 262.e1
Main Authors:	Leveille, Cameron F., Freeman, Shane R., Kosalka, Pauline K., Hamel, Erik M., Churchill, Isabella F., Giesbrecht, Janice, Setrak, Rafi F., Law, Madelyn
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-03-2020 Elsevier Limited
Subjects:	Adult Aged Aged, 80 and over Antibiotics Bias Cancer Chart reviews Chemotherapy Clinical outcomes Emergency medical care Emergency nursing Emergency Nursing - methods Emergency Service, Hospital Emergency services Febrile neutropenia Female Fever - diagnosis Fever - etiology Fever - therapy Health care expenditures Health status High risk Humans Infections Laboratories Male Middle Aged Morbidity Mortality Neoplasms - complications Neoplasms - drug therapy Neutropenia Neutropenia - diagnosis Neutropenia - etiology Neutropenia - therapy Nurse-initiated protocols Nurses Nursing Oncology Patient admissions Patients Physicians Retrospective Studies Sepsis Time Triage Triage - methods Waiting times Young Adult Triage Emergency nursing Nurse-initiated protocols Febrile neutropenia
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Fever during chemotherapy is a common and potentially severe complication being increasingly evaluated in emergency departments to minimize morbidity and mortality. Streamlining triage of these patients may improve health outcomes and wait times in the health care system. A retrospective chart review of febrile patients undergoing chemotherapy was conducted at a local emergency department to assess the impact of nurse-initiated protocols on wait times. We identified 315 patients undergoing current chemotherapy presenting with fever. Of these, 140 (44%) and 87 (28%) were initiated on the sepsis and febrile neutropenia nurse-initiated protocols, respectively. In total, 197 (63%) were admitted. The febrile neutropenia protocol had a shorter wait time from triage to disposition than the sepsis protocol (403 minutes [SD = 23] vs 329 minutes [SD = 19], t = 1.71, P = 0.01). Furthermore, the febrile neutropenia protocol demonstrated shorter times from both triage to lab results reported, in addition to the physician initial assessment in the admitted patient subgroup. Decreased wait times from triage associated with the use of a febrile neutropenia protocol could be accounted for by a lower number of lab results required through this protocol in addition to shorter physician assessment times in the admitted population. This study shows that nurse-initiated protocols may influence door-to-antibiotic time for patients undergoing chemotherapy. By having a targeted protocol for the cancer population, health care centers may be able to demonstrate decreased health care expenditure and increased resource availability. Furthermore, as the current population of patients undergoing chemotherapy is at a high risk for neutropenia, prompt management is crucial to minimize mortality.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0099-1767 1527-2966
DOI:	10.1016/j.jen.2019.12.007