MASCC and you shall receive: A quality improvement initiative in febrile neutropenia management.

480 Background: Oncology patients are at increased risk of immunodeficiency due to both underlying malignancy and therapeutic interventions. Proper and efficient evaluation of febrile neutropenia is essential to improving outcomes in this patient population. The Multinational Association for Supportive Care in Cancer (MASCC) score is a validated tool used to measure the risk of complications related to neutropenic fever. Scores greater than or equal to 21 are considered low risk for complications and can be considered for outpatient management, while scores less than 21 are high risk for complications and should be admitted to the hospital for intravenous antibiotics. Methods: The electronic medical record was queried for any patients with the diagnosis of “febrile neutropenia” from 2017-2022. Other search terms included the combination of “fever” and “cancer”. Patients hospitalized for induction chemotherapy or stem cell transplantation were excluded. We documented MASCC scores if present. Retrospective MASCC scores were then calculated on all patients. Providers who commonly triage patients with febrile neutropenia were surveyed to understand current use of the MASCC score at our institution. Results: A total of 337 patients hospitalized with neutropenic fever were included for review. 175 (52%) of patients had a history of solid organ malignancy, while 162 (48%) had hematologic malignancy. 11 patients (3%) had a documented MASCC score. The average retrospective MASCC score was 19.7. About half of patients (49.5%) had a retrospective MASCC score less than 21 and half (50.5%) had a score greater than or equal to 21. Half of practitioners surveyed endorsed the use of MASCC score in triage decisions. Conclusions: Our results show half of patients hospitalized with febrile neutropenia at our institution in the last five years had a low-risk retrospective MASCC score, indicating an opportunity to reduce the admission rate in this patient population. The results of the provider survey reflected a much higher self-reported use of MASCC scores than was actually documented in the electronic medical record. Together, this identified an opportunity to improve both the utilization of MASCC score implementation and documentation to appropriately triage patients with febrile neutropenia and avoid unnecessary hospitalizations. We are now working on a quality improvement initiative to automate the use of the MASCC score in our electronic medical records.