Home-based care of low-risk febrile neutropenia in children-an implementation study in a tertiary paediatric hospital.

Haeusler, GM; Gaynor, L; Teh, B; Babl, FE; Orme, LM; Segal, A; Mechinaud, F; Bryant, PA; Phillips, B; Lourenco, RDA; Slavin, MA; Thursky, KA

Home-based care of low-risk febrile neutropenia in children-an implementation study in a tertiary paediatric hospital.

Haeusler, GM Gaynor, L Teh, B Babl, FE Orme, LM Segal, A Mechinaud, F Bryant, PA Phillips, B Lourenco, RDA Slavin, MA Thursky, KA

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Publisher:: Springer
Publication Type:: Journal Article
Citation:: Supportive Care in Cancer, 2021, 29, (3), pp. 1609-1617
Issue Date:: 2021-03

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Field	Value	Language
dc.contributor.author	Haeusler, GM
dc.contributor.author	Gaynor, L
dc.contributor.author	Teh, B
dc.contributor.author	Babl, FE
dc.contributor.author	Orme, LM
dc.contributor.author	Segal, A
dc.contributor.author	Mechinaud, F
dc.contributor.author	Bryant, PA
dc.contributor.author	Phillips, B
dc.contributor.author	Lourenco, RDA
dc.contributor.author	Slavin, MA
dc.contributor.author	Thursky, KA
dc.date.accessioned	2021-12-20T01:56:53Z
dc.date.available	2020-07-24
dc.date.available	2021-12-20T01:56:53Z
dc.date.issued	2021-03
dc.identifier.citation	Supportive Care in Cancer, 2021, 29, (3), pp. 1609-1617
dc.identifier.issn	0941-4355
dc.identifier.issn	1433-7339
dc.identifier.uri	http://hdl.handle.net/10453/152406
dc.description.abstract	<h4>Background</h4>Home-based management of low-risk febrile neutropenia (FN) is safe, improves quality of life and reduces healthcare expenditure. A formal low-risk paediatric program has not been implemented in Australia. We aimed to describe the implementation process and evaluate the clinical impact.<h4>Method</h4>This prospective study incorporated three phases: implementation, intervention and evaluation. A low-risk FN implementation toolkit was developed, including a care-pathway, patient information, home-based assessment and educational resources. The program had executive-level endorsement, a multidisciplinary committee and a nurse specialist. Children with cancer and low-risk FN were eligible to be transferred home with a nurse visiting daily after an overnight period of observation for intravenous antibiotics. Low-risk patients were identified using a validated decision rule, and suitability for home-based care was determined using disease, chemotherapy and patient-level criteria. Plan-Do-Study-Act methodology was used to evaluate clinical impact and safety.<h4>Results</h4>Over 18 months, 292 children with FN were screened: 132 (45%) were low-risk and 63 (22%) were transferred to home-based care. Compared with pre-implementation there was a significant reduction in in-hospital median LOS (4.0 to 1.5 days, p < 0.001) and 291 in-hospital bed days were saved. Eight (13%) patients needed readmission and there were no adverse outcomes. A key barrier was timely screening of all patients and program improvements, including utilising the electronic medical record for patient identification, are planned.<h4>Conclusion</h4>This program significantly reduces in-hospital LOS for children with low-risk FN. Ongoing evaluation will inform sustainability, identify areas for improvement and support national scale-up of the program.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Springer
dc.relation.ispartof	Supportive Care in Cancer
dc.relation.isbasedon	10.1007/s00520-020-05654-z
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	11 Medical and Health Sciences, 17 Psychology and Cognitive Sciences
dc.subject.classification	Oncology & Carcinogenesis
dc.subject.mesh	Adolescent
dc.subject.mesh	Child
dc.subject.mesh	Child, Preschool
dc.subject.mesh	Febrile Neutropenia
dc.subject.mesh	Female
dc.subject.mesh	Home Care Services
dc.subject.mesh	Hospitals, Pediatric
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Quality of Life
dc.subject.mesh	Tertiary Care Centers
dc.subject.mesh	Humans
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Quality of Life
dc.subject.mesh	Adolescent
dc.subject.mesh	Child
dc.subject.mesh	Child, Preschool
dc.subject.mesh	Hospitals, Pediatric
dc.subject.mesh	Home Care Services
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Tertiary Care Centers
dc.subject.mesh	Febrile Neutropenia
dc.subject.mesh	Adolescent
dc.subject.mesh	Child
dc.subject.mesh	Child, Preschool
dc.subject.mesh	Febrile Neutropenia
dc.subject.mesh	Female
dc.subject.mesh	Home Care Services
dc.subject.mesh	Hospitals, Pediatric
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Quality of Life
dc.subject.mesh	Tertiary Care Centers
dc.title	Home-based care of low-risk febrile neutropenia in children-an implementation study in a tertiary paediatric hospital.
dc.type	Journal Article
utslib.citation.volume	29
utslib.location.activity	Germany
utslib.for	11 Medical and Health Sciences
utslib.for	17 Psychology and Cognitive Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
pubs.organisational-group	/University of Technology Sydney/Centre for Health Technologies (CHT)
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Centre for Health Economics Research and Evaluation
utslib.copyright.status	closed_access	*
pubs.consider-herdc	true
dc.date.updated	2021-12-20T01:56:52Z
pubs.issue	3
pubs.publication-status	Published
pubs.volume	29
utslib.citation.issue	3

Abstract:

Background

Home-based management of low-risk febrile neutropenia (FN) is safe, improves quality of life and reduces healthcare expenditure. A formal low-risk paediatric program has not been implemented in Australia. We aimed to describe the implementation process and evaluate the clinical impact.

Method

This prospective study incorporated three phases: implementation, intervention and evaluation. A low-risk FN implementation toolkit was developed, including a care-pathway, patient information, home-based assessment and educational resources. The program had executive-level endorsement, a multidisciplinary committee and a nurse specialist. Children with cancer and low-risk FN were eligible to be transferred home with a nurse visiting daily after an overnight period of observation for intravenous antibiotics. Low-risk patients were identified using a validated decision rule, and suitability for home-based care was determined using disease, chemotherapy and patient-level criteria. Plan-Do-Study-Act methodology was used to evaluate clinical impact and safety.

Results

Over 18 months, 292 children with FN were screened: 132 (45%) were low-risk and 63 (22%) were transferred to home-based care. Compared with pre-implementation there was a significant reduction in in-hospital median LOS (4.0 to 1.5 days, p < 0.001) and 291 in-hospital bed days were saved. Eight (13%) patients needed readmission and there were no adverse outcomes. A key barrier was timely screening of all patients and program improvements, including utilising the electronic medical record for patient identification, are planned.

Conclusion

This program significantly reduces in-hospital LOS for children with low-risk FN. Ongoing evaluation will inform sustainability, identify areas for improvement and support national scale-up of the program.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/152406