CBC testing before physician assessment delays antibiotics in Emergency Febrile Neutropenia patients

Ben-Yakov M, Eftekhary S, Kiss A, Schull MJ

Objective: Febrile neutropenia (FN) has high mortality and requires prompt antibiotic

therapy. Emergency Department (ED) processes, such as standing orders for blood tests

at triage, may reduce delays. We evaluated whether having complete blood counts

(CBC) available prior to first physician assessment was associated with shorter door-toantibiotic

(DTA) time.

Methods: Electronic and chart data was reviewed on 83 FN patients admitted to a

tertiary care center over 11 months. DTA time was calculated from triage to delivery of

drug. The main predictor was CBC result available before physician encounter.

Results: Among 72 patients included, 36% were male, with a mean age of 58±14. All

were given high acuity triage codes, 50% had CBC results available when first assessed

by the ED physician; their mean DTA time was longer than those who did not have a

CBC available (224 min vs 83, p < 0.05). Although 90% of patients were diagnosed as “FN” in the ED, 93% were treated with IV antibiotics. In multivariable regression analysis, seeing a physician before CBC results was associated with shorter DTA time (–84 min, p = 0.0514), while weekend cases were associated with a longer DTA time (+151 min, p = 0.0023). Conclusion: DTA time is a feasible measure of quality of care for FN patients. Most patients are diagnosed and treated in ED. Our findings do not suggest that having a CBC result available at the first physician assessment reduces DTA time.

Ben-Yakov M, Eftekhary S, Kiss A, Schull MJ