Reducing Inpatient Hospital Days for Cancer Patients with Fever

Published on in CHOP News

Stylized child iconImprove Outcomes
House iconKeep Kids out of the Hospital

Why is this important?

Chemotherapy used to treat children with cancer suppresses their immune system. This puts them at increased risk for serious bacterial infections especially when their white blood cell count (WBC) is very low. Fever is often the only sign of serious infection and must be treated urgently with hospital admission and intravenous antibiotics. Children with very low WBC counts were hospitalized until these counts increased, which can take several weeks. Recent evidence shows that children who meet low-risk criteria can be treated with oral antibiotics at presentation or following a briefer hospital stay.

What we did

Experts from the Cancer Center, Emergency Department (ED), Infectious Diseases and Pharmacy at Children's Hospital of Philadelphia (CHOP) came together to incorporate this new evidence in the existing Oncology/Fever pathway. They developed low-risk criteria that could identify children who could be treated safely with oral antibiotics at presentation or following a short hospitalization. The team developed a reliable patient follow-up process. They piloted this new process and then implemented the change. The team reviewed all the charts of these patients and collected data to assure effectiveness and safety.


Percent of Oncology Patients with Fever and Neutropenia Admitted for IV Antibiotic Treatment

Identification of low-risk criteria allowed 15 percent of neutropenic ED and Oncology Clinic patients with fever to be treated and then discharged to continue treatment at home.

Percent of Oncology Patients with Fever and Neutropenia Admitted for IV Antibiotic Treatment Graph

Hospital length of Stay for Oncology Patients with Fever and Neutropenia After Pathway Implementation

Febrile neutropenic patients meeting low risk criteria were spared hospitalization coming from both the Emergency Department (ED) and the Outpatient Oncology Clinic (OP).

Graph: Median inpatient length of stay
Graph: Average inpatient days

Updated May, 2020

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