Early Supported Discharge for patients with febrile neutropenia – Experience at a large district hospital in the UK

Early Supported Discharge for patients with febrile neutropenia – Experience at a large district hospital in the UK

Neutropenic sepsis can be life threatening, with mortality 2-21%. The heterogeneity of patients referred with “suspected neutropenic sepsis” has led to strategies being developed to risk-stratify patients and identify those with a low risk of septic complications that could be managed in the outpatient setting, such as The Multinational Association for Supportive Care in Cancer score (MASCC).

Outcomes for patients referred with suspected neutropenic sepsis were assessed before and after use of MASCC guided early-supported discharge.

50/123 (41%) patients over 24 months were eligible for early-supported discharge. 26/50 patients had same-day discharge, 14 had overnight admission, 8 stayed 2 nights and 2 stayed 3 nights. Patients received on average 2 follow-up telephone consultations. There were 5 readmissions (10%) and no adverse events. In comparison group; 8 patients over 3-months would have been suitable, potentially saving 40 bed-days.

This shows MASCC guided early-supported discharge is safe and cost-effective.

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References

  1. Herbst C, Naumann F, Kruse E, Knauel I, Schulz H, Bohlius J, et al. Prophylactic antibiotics and G-CSF for the prevention of infections and improvement of survival in cancer patients undergoing chemotherapy. In: The Cochrane Collaboration, editor. Cochrane Database of Systematic Reviews [Internet]. Chichester, UK: John
    Wiley & Sons, Ltd; 2008 [cited 2016 Sep 24]. Available from: http://doi.wiley.com/10.1002/14651858.CD007107
  2. Rosa RG, Goldani LZ. Cohort study of the impact of time to antibiotic administration on mortality in patients with febrile neutropenia. Antimicrob Agents Chemother. 2014 Jul;58(7):3799–803.
  3. Salstrom JL, Coughlin RL, Pool K, Bojan M, Mediavilla C, Schwent W, et al. Pediatric patients who receive antibiotics for fever and neutropenia in less than 60 min have decreased intensive care needs. Pediatr Blood Cancer. 2015 May;62(5):807–15.
  4. Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, et al. The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol Off J Am Soc Clin Oncol. 2000 Aug;18(16):3038–51.
  5. Klastersky J, Paesmans M, Georgala A, Muanza F, Plehiers B, Dubreucq L, et al. Outpatient oral antibiotics for febrile neutropenic cancer patients using a score predictive for complications. J Clin Oncol Off J Am Soc Clin Oncol. 2006 Sep 1;24(25):4129–34.
  6. Klastersky J, Paesmans M. The Multinational Association for Supportive Care in Cancer (MASCC) risk index score: 10 years of use for identifying low-risk febrile neutropenic cancer patients. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2013 May;21(5):1487–95.
  7. Uys A, Rapoport BL, Anderson R. Febrile neutropenia: a prospective study to validate the Multinational Association of Supportive Care of Cancer (MASCC) risk-index score. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2004 Aug;12(8):555–60.
  8. Baskaran ND, Gan GG, Adeeba K. Applying the Multinational Association for Supportive Care in Cancer risk scoring in predicting outcome of febrile neutropenia patients in a cohort of patients. Ann Hematol. 2008 Jul;87(7):563–9.
  9. National Collaborating Centre for Cancer. Neutropenic Sepsis: Prevention and Management of Neutropenic Sepsis in Cancer Patients [Internet]. London: National Institute for Health and Clinical Excellence (UK); 2012 [cited 2016 Sep 24]. (National Institute for Health and Care Excellence: Guidance). Available from:
    http://www.ncbi.nlm.nih.gov/books/NBK299128/
  10. Cooksley T, Holland M, Klastersky J. Ambulatory Outpatient Management of patients with low risk febrile neutropaenia. Acute Med. 2015;14(4):178–81.
  11. Innes H, Marshall E. Outpatient therapy for febrile neutropenia. Curr Opin Oncol. 2007 Jul;19(4):294–8.
  12. Elting LS, Lu C, Escalante CP, Giordano SH, Trent JC, Cooksley C, et al. Outcomes and cost of outpatient or inpatient management of 712 patients with febrile neutropenia. J Clin Oncol Off J Am Soc Clin Oncol. 2008 Feb 1;26(4):606–11.
  13. Innes H, Lim SL, Hall A, Chan SY, Bhalla N, Marshall E. Management of febrile neutropenia in solid tumours and lymphomas using the Multinational Association for Supportive Care in Cancer (MASCC) risk index: feasibility and safety in routine clinical practice. Support Care Cancer Off J Multinatl Assoc Support Care Cancer.
    2008 May;16(5):485–91.
  14. Taplitz RA, Kennedy EB, Bow EJ, Crews J, Gleason C, Hawley DK, et al. Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline Update. J Clin Oncol. 2018 Feb 20;JCO.2017.77.621.
  15. Botten J, Beard J, Zorzi A, Thompson A. A simple intervention to improve antibiotic treatment times for neutropenic sepsis. Acute Med. 2016;15(1):3–6.
  16. Monitor. Monitor. Closing the NHS Funding Gap: how to get better value healthcare for patients. 2013.
  17. Chisholm JC, Dommett R. The evolution towards ambulatory and day-case management of febrile neutropenia. Br J Haematol. 2006 Oct;135(1):3–16.
  18. Innes HE, Smith DB, O’Reilly SM, Clark PI, Kelly V, Marshall E. Oral antibiotics with early hospital discharge compared with inpatient intravenous antibiotics for low-risk febrile neutropenia in patients with cancer: a prospective randomised controlled single centre study. Br J Cancer. 2003 Jul 7;89(1):43–9.

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Early Supported Discharge for patients with febrile neutropenia – Experience at a large district hospital in the UK

5th April 2019
PMID: 32608388
Authors Affiliations
Clair I. W. Brunner MB BChir MRCP, Oncology Trust Grade Doctor at Taunton and Somerset NHS Foundation Trust
Joanne Botten MB BSc (Hons), MRCP (Med Oncology); Taunton and Somerset NHS Foundation Trust
Nic Wennike FRCP; Taunton and Somerset NHS Foundation Trust
Lucy Ford RGN; Taunton and Somerset NHS Foundation Trust
Kathryn Michaels RGN Onc Cert BSc Hons; Taunton and Somerset NHS Foundation Trust
Anna Stephens RGN; Taunton and Somerset NHS Foundation Trust
Robert Baker PhD; Taunton and Somerset NHS Foundation Trust

Early Supported Discharge for patients with febrile neutropenia – Experience at a large district hospital in the UK

Cite this article as:

Brunner C, Botten J, Wennike N, Ford L, Michaels K, Stephens A, Baker R. Early Supported Discharge for patients with febrile neutropenia - Experience at a large district hospital in the UK. Acute Med. 2019;18(1):14-19. PMID: 32608388.

Early Supported Discharge for patients with febrile neutropenia – Experience at a large district hospital in the UK

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