CJEM. 2026 Feb 3. doi: 10.1007/s43678-026-01091-9. Online ahead of print.
ABSTRACT
INTRODUCTION: Management of febrile neutropenia in previously healthy, presumed immunocompetent children varies. Unnecessary treatment impacts the patients, families, and the healthcare system. With guidance from a Canadian Paediatric Society Practice Point, most well-appearing children with a first episode of febrile neutropenia can be managed with reduced exposure to antibiotics and close outpatient follow-up. The aim of this initiative was to safely reduce antibiotic use in this low-risk population presenting to the emergency department (ED).
METHODS: A multidisciplinary team designed a quality improvement (QI) initiative. From July 2022 to July 2024, treatment with antibiotics was classified as indicated or non-indicated according to guidance from the Practice Point. Interventions involved guideline dissemination, provider education, and point-of-care tools to facilitate clinical decision-making and follow-up. Outcome measures included the proportion of children receiving antibiotics, hospital admission, and appropriate laboratory follow-up. Re-presentation to ED and missed serious bacterial infections were monitored as balancing measures. Analysis of the primary outcome was by statistical process control.
RESULTS: Three hundred and ninety-eight (398) children with febrile neutropenia were included. The proportion of non-indicated antibiotics was 6.7% at baseline. Statistical process control analysis of the G-chart demonstrated special cause variation with 97 consecutive cases occurring without error (non-indicated antibiotics). Following the occurrence of special cause variation until the end of the study, only 1.6% of children received non-indicated antibiotics. There was no increase in re-presentations to ED (9% vs 8%; p = 0.65) nor missed serious bacterial infections (0% vs 0%).
CONCLUSIONS: Quality improvement methodology can facilitate the timely adoption of best practices to align local clinical care with new national guidelines. Implementation of the national guideline allowed low-risk children with febrile neutropenia to avoid overtreatment.
PMID:41632376 | DOI:10.1007/s43678-026-01091-9
