The effectiveness of the Canadian triage guidelines in improving the treatment outcomes of cancer patients with febrile neutropenia

Alsharawneh, Anas (2019) The effectiveness of the Canadian triage guidelines in improving the treatment outcomes of cancer patients with febrile neutropenia. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Background: Febrile neutropenia (FN) is among the most common side effects related to cancer treatment and a significant cause of morbidity and mortality. Patients with FN are at a higher risk of developing life-threatening sepsis without prompt treatment. Purpose: To evaluate the quality of emergency care of cancer patients with FN. Specifically, the study aimed to examine the effectiveness of triage on select treatment outcomes for patients with FN as specified by the Canadian triage guidelines. Methods: A retrospective cohort design was employed to collect data over five years from the emergency department (ED) records of all adult cancer patients with FN in one urban health care organization in Atlantic Canada. Results: The Canadian triage guidelines identify the acuity and urgency of FN. The guidelines, however, do not translate well in practice as two-thirds of the patient sample were inappropriately triaged (mal-triaged) to less urgent triage categories. Mal-triage was significantly associated with delayed times for physician initial assessment, administration of antibiotics, and decision about admission. Additional factors that contributed to the quality of ED care of cancer patients with FN were also examined. Conclusion: The results of our quality evaluation provided evidence that improvements in a number of the quality dimensions have the potential to enhance the care provided to individuals with FN. Our results established an initial understanding of the factors that influence the mal-triage of patients with FN. Improving triage decision-making is an essential first step but this will not completely improve the quality of care in the ED for clients presenting with FN until problems in other parts of the system are resolved to address the health care outcomes and needs of this vulnerable population.

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