Use of Data from a Fever Registry (FEVEREG) to Identify Quality Improvement Opportunities in a Third-Level Hospital in Panama

Abstract Background Infectious diseases in childhood cancer patients are frequent and increase the morbimortality of these patients. Hospital del Niño doctor José Renán Esquivel initiated data collection in a registry of fever and neutropenia (FEVEREG) to evaluate outcomes and management of these diseases and identify opportunities for quality improvement. The objective of this study is to describe data collected to date. Methods Data was collected through a data collection instrument (CRF) using Trial Master platform. It was analyzed with R Data Analytics (version 4.3.2) and descriptive statistics summarized. Only patients who were admitted due to the febrile episode or were hospitalized when fever started were included. Results From Sept 2021 to October 2023, we captured 138 episodes in 70 patients, with a mean age of 8 years (range 0-15) and a similar percentage of female and male patients. The most common diagnosis was acute lymphoblastic leukemia (57.14%) and the episodes occurred more during the induction phase (24%) and in patients with a relapse protocol (31.5%). The time of administration of the antibiotic varied depending on the patient location at fever onset. 44% of outpatients (46/105) received the first dose of antibiotic more than 4 hours after the onset of fever, while hospitalized patients received this dose in the first hour in 64% of cases (21/33). Time from registration of outpatients until the first dose of antibiotic was an average of 71 minutes, with 60% of the patients receiving the antibiotic during the first 60 minutes. In 45.8% of the episodes, a blood culture was taken before starting the antibiotic. The febrile neutropenia algorithm was followed on 64.5% of the days evaluated, with the main cause of deviation being treatment to the focus of infection (55%) followed by clinical decision (41%). Bacteremia occurred in 26% of episodes (20/78) and 14% of episodes had documented viral infection (11/78). The most frequently isolated bacteria in blood was Pseudomonas aeruginosa (13/33, 39.3%). Approximately 4% of the episodes (6/138) were admitted to the intensive care unit and died, half from septic shock and half from progressive disease. The average length of hospital stay was 12 days. Conclusion Data from FEVEREG has suggested opportunities for quality improvement in time to antibiotics and use of guideline compliant antibiotics (antimicrobial stewardship).