Process Analysis of Time to Antibiotics in Pediatric Patients With Fever in Neutropenia During Chemotherapy for Cancer

For fever in neutropenia (FN) during chemotherapy timely start of antibiotics is recommended. We analyzed time to antibiotics (TTA) and sub-timespans between detection of fever and start of antibiotics in children undergoing chemotherapy for cancer with FN. Specifically, we aimed to assess where delays occur, which variables influence TTA, and whether the order of certain process steps affects TTA. We analyzed 349 FN episodes reported prospectively in 155 Swiss patients from April 2016 to August 2018. In outpatients, the median TTA from fever to the start of antibiotics was 165 minutes, and the median duration from fever to hospital arrival was 80 minutes. For inpatients, the median TTA from fever to the start of antibiotics was 75 minutes. The longest delays were identified for the timespans from phone call to arrival (median, 75 min) and from arrival to decision on treatment (60 min). Known blood counts at recognition of fever, decision to treat FN before arrival at the emergency department, and arrival during office hours contributed to shorter TTA. In conclusion, the time before arrival is relevant and should be considered when optimizing TTA and evaluating its influence on outcomes. Support for transportation, using time to arrive for preparations, and regular blood counts could reduce TTA.