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Feasibility of early discharge strategies for neutropenic fever: outcomes of a V ictorian organisational readiness assessment and pilot
Author(s) -
Lingaratnam S.,
Mellerick A.,
Worth L. J.,
Green M.,
Guy S.,
Kirsa S.,
Slavin M.,
Renwick W.,
Filshie R.,
Thursky K. A.
Publication year - 2013
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12228
Subject(s) - medicine , ambulatory , interquartile range , audit , emergency medicine , baseline (sea) , prospective cohort study , ambulatory care , health care , surgery , oceanography , management , economic growth , economics , geology
Background Although A ustralian consensus guidelines support the use of ambulatory care strategies for management of adult patients with low‐risk neutropenic fever ( NF ), few centres have successfully implemented viable programmes. Aims To study the feasibility of an early discharge programme for adult patients with low‐risk NF and assess organisational factors likely to influence successful implementation across participating V ictorian hospitals. Methods Four hospitals participated in an organisational readiness assessment preceding selection of a pilot site for programme implementation. Prospective baseline auditing of current practice (i.e. inpatient care until resolution of NF ) across three hospitals preceded programme implementation and evaluation. Results Barriers and facilitators to successful implementation were identified. One hundred and seventeen NF episodes were evaluated during audit phases. The frequency of low‐risk NF presentations eligible for early discharge was low (less than two episodes per week). The programme reduced median (interquartile range) duration of parenteral antibiotics and length of stay for eligible patients ( n = 11 ) from 4 (4, 5) days at baseline to 1 (1, 2) day during pilot ( P = 0.02) and 4.5 (4, 5) days (baseline) to 2 (1, 3) days (pilot) ( P = 0.02) respectively. The proportion of ineligible patients stepped down to oral antibiotics was improved from 38% (baseline) to 67% (pilot). No patients failed ambulatory care requiring readmission into hospital. Conclusion The ambulatory care strategy for management of NF proposed by A ustralian consensus guidelines has been successfully piloted at a single V ictorian centre. Organisational readiness tools can be used to identify potential barriers to the implementation of evidence based practices in patients with NF .