WIP 11 - Optimizing Care for Febrile Neutropenia: A Quality Improvement Initiative to De-escalate Antibiotic Use in Pediatric Oncology.

Publication Number: WIP 11.7696

Sridhi Patel, University of Florida College of Medicine, Jacksonville, FL, United States; Scott M.. Bradfield, Nemours Children's Health - Jacksonville, Jacksonville, FL, United States; Ahmad Hachem, University of Florida College of Medicine, Jacksonville, FL, United States; Jessica Lindquist, University of Florida - Jacksonville, College of Medicine, Jacksonvile, FL, United States

Background: Febrile neutropenia is a common complication for pediatric oncology patients traditionally treated by broad spectrum antibiotics until neutrophil count recovery is achieved. This often leads to prolonged hospitalizations and recurrent antibiotic exposure, thus increasing the risk of developing antibiotic resistance. In 2023, the International Pediatric Fever and Neutropenia Guideline Panel released new clinical practice guidelines, recommending the discontinuation of antimicrobial therapy in low-risk febrile neutropenia patients who were clinically stable, afebrile for at least 24 hours, and had negative blood cultures after 48 hours.

Objective: Using quality improvement methodology, we hypothesize by de-escalating antimicrobial therapy in low-risk febrile neutropenia oncology patients we will decrease our average length of stay by 30% from 80 hours to 55 hours over a 12 month time period.

Design/Methods: After receiving IRB exempt status, a retrospective chart review of eligible patients admitted to a single-institution tertiary care center was performed. Using the Model for Improvement, the framework for the FN-QI was established. A list of patients admitted from 8/2023 to 8/2024 was generated and filters for ICD codes for “febrile", "neutropenia”, and “bacteremia” were all applied. Inclusion criteria of pediatric oncology diagnosis, 101F were identified and remainder were removed. Patient demographics, length of stay (outcome), antibiotics used, microbial identification, readmission rates/adverse events (outcome), and viral identification were collected. Run charts were used to track monthly progress on outcome measurements. Cycle assessments on the impact of the interventions utilized the Plan, Do, Study, Act (PDSA) methodology. The QI methods started 3/2024, with the first two PDSA cycles completed 11/2024. The final cycle will end 01/2025. The statistical analysis will use process control charts, independent t-test to compare pre and post intervention outcomes, and chi-square test to compare readmissions/adverse outcomes.