Advanced Practice

Febrile Neutropenia: Decreasing Time to Antibiotic Administration in a Community Hospital Emergency Department

Susan D. Bruce

febrile neutropenia, time to antibiotic administration, emergency department
CJON 2021, 25(1), 23-26. DOI: 10.1188/21.CJON.23-26

Febrile neutropenia, a serious complication of cytotoxic chemotherapy, is an oncologic emergency associated with high rates of morbidity and mortality. Fever is often the only clinical sign of an underlying infection in neutropenic patients with cancer. Prompt treatment with empiric broad-spectrum antibiotics is crucial to ensuring best outcomes for patients; practice guidelines recommend antibiotic administration within one hour of fever onset. A quality improvement initiative to improve time to antibiotic administration among patients with febrile neutropenia presenting to a community hospital emergency department is described in this article.


  • Neutropenia is a dose-limiting toxicity of chemotherapy administration that predisposes patients with cancer to serious infection.
  • Failure to meet the one-hour guideline to administration of antibiotics can lead to increased morbidity, mortality, and hospital length of stay.
  • Identification of key areas for improvement using evidence-based strategies can improve adherence to guideline-based practice in the treatment of febrile neutropenia.
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