Pretreatment assessment for febrile neutropenia and sepsis risk: Utilizing growth factors to reduce hospital readmissions.

455 Background: Emergency department (ED) visits and hospital admissions among oncology patients undergoing chemotherapy may be linked to diagnoses of febrile neutropenia, neutropenia, and sepsis. OP-35 measure used by CMS assesses the rate of inpatient admissions and emergency department visits within 30 days of outpatient chemotherapy, assessing preventable conditions including febrile neutropenia (FN) and sepsis. This project focused on these conditions to implement interventions to reduce such admissions. Methods: Cases within 30 days of chemotherapy were identified from institutional data and patient records were reviewed to classify reasons for ED visit and hospital admission, as well as chemotherapy regimen given. Drug regimens with higher association with admission were identified. NCCN guidelines for use of G-CSF prophylaxis with regimens associated with an intermediate risk of FN (10-20%) were identified for intervention. Results: Data were extracted for dates 1/3/2022 to 12/19/2023, identifying 146 patients (both Medicare and non-Medicare) admitted with cytopenia-related diagnoses. Among these, 33% were found to be neutropenic (ANC < 1.5). Taxane and platin containing regimens, as well as FOLFOX and R-CHOP had the highest rates of FN resulting in ED visit. The pilot intervention phase accessed pre-assessment protocols for FN risk by pharmacists and physicians to identify patients who may benefit from the addition of G-CSF prior to or during treatment. Pharmacists flagged patients based on the defined risk assessment criteria checklist and discussed these cases with the oncologist. Through a collaborative, shared decision-making process, the care team determined whether to initiate prophylactic growth factors. Of 14 patients in the pilot phase, 12 received G-CSF and none presented to the ED for FN. One of 2 patients not receiving G-CSF was admitted through the ED for FN. Conclusions: This pilot fostered collaboration between pharmacists and treating physicians by promoting an evidence-based approach to incorporating growth factors into chemotherapy regimens, particularly in cases with a 10–20% risk of febrile neutropenia. No patients selected for G-CSF had an ED visit or admission. For next steps the pilot process will be expanded across the Oncology service line and additional efficacy data will be collected.