Establishment of an outpatient acute care clinic (ACC) decreased time from fever to antibiotic administration among patients with hematologic malignancies experiencing febrile neutropenia (FN). These findings were published in Clinical Journal of Oncology Nursing.

As many as 80% of patients receiving cytotoxic chemotherapy for hematologic malignancies develop FN. Without appropriate and timely management, patients can experience severe complications, including death.

This quality improvement project was designed to develop an ACC embedded in an established infusion center at Duke University Hospital in Durham, North Carolina, in 2020-2021. Management of FN was compared prior to and after the ACC program launch.

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The ACC treatment process was triggered when a patient with hematologic malignancy contacted the ACC with a fever. The patient was immediately scheduled for infusion and assigned to a registered nurse for management. Once the patient arrived at the clinic, they were examined, and intravenous antibiotics were administered. The patient was discharged or admitted to the hospital depending on posttreatment vital signs.

This study included 15 pre-ACC patients and 16 post-ACC patients, mean ages 57.44 and 60.88 years, and 4 and 7 were women, respectively.

The mean time from fever to antibiotic administration was 144.88 minutes (SD, 86.75)  before compared with 63.69 minutes (SD, 75.65) after the ACC was established (t, 2.82; P =.008). Significantly more patients received antibiotics within 1 hour of fever at the ACC (P <.001), and patients were satisfied with the ACC.

The limitations of this study included the single-center design and small sample size.

These data indicated that a dedicated ACC process for patients with hematologic malignancies reduced time from FN symptom onset to antibiotic administration.


Frith J, Allen D, Minor K, Reynolds SS. Febrile neutropenia: improving care through an oncology acute care clinic. Clin J Oncol Nurs. 2023;27(1):33-39. doi:10.1188/23.CJON.33-39