{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T22:51:55Z","timestamp":1785883915906,"version":"3.56.0"},"reference-count":58,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T00:00:00Z","timestamp":1627516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR001422"],"award-info":[{"award-number":["UL1TR001422"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Earlier initial antibiotic treatment for febrile neutropenia is associated with improved clinical outcomes. This study was conducted to evaluate the association of an emergency department (ED) intervention protocol with time to initial antibiotic treatment for febrile neutropenia patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a cohort study of adult ED febrile neutropenia patients before and after implementation of an intervention protocol. Analyses included comparison of means and medians, Kaplan\u2010Meier estimates, multivariable regression analyses, interrupted time\u2010series analyses, and causal mediation analyses. The intervention protocol included specific triage and process\u2010of\u2010care actions to reduce the primary outcome of time to initial antibiotic treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 69 patients in the 12\u2010month preintervention period and 52 patients in the 8\u2010month postintervention period. The mean (\u00b1SD) times to initial antibiotics were 197.6 (\u00b185.4)\u00a0min for the preintervention group and 97.7 (\u00b151.0)\u00a0min for the postintervention group (difference of 99.9\u00a0min with 95% confidence interval [CI]\u00a0= 73.5 to 126.4, p\u00a0&lt;\u00a00.001). The patients\u2019 probability for receiving initial antibiotics within 90\u00a0min was severalfold greater (adjusted risk ratio\u00a0= 10.31, 95% CI\u00a0= 4.99 to 21.30, p\u00a0&lt;\u00a00.001) for the postintervention group versus preintervention group. ED length of stay, hospital length of stay, 30\u2010day readmissions, and 30\u2010day all\u2010cause mortality were not different between the study groups. The association of the intervention protocol with time to initial antibiotics appeared to be mediated through times to treatment room placement, report of absolute neutrophil count, and initial antibiotic order.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The intervention protocol was associated with a significant reduction in time to initial antibiotics for ED patients with febrile neutropenia. This association appears to be facilitated through specific intermediate process\u2010of\u2010care variables. A larger multicenter study is needed to assess the potential effects of an ED febrile neutropenia protocol on patient\u2010centered clinical outcomes and resource utilization.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14335","type":"journal-article","created":{"date-parts":[[2021,7,10]],"date-time":"2021-07-10T19:22:12Z","timestamp":1625944932000},"page":"73-82","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Association of an emergency department febrile neutropenia intervention protocol with time to initial antibiotic treatment"],"prefix":"10.1111","volume":"29","author":[{"given":"Justin A.","family":"Seltzer","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Frankfurt","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0885-8426","authenticated-orcid":false,"given":"Demetrios N.","family":"Kyriacou","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"},{"name":"Department of Preventive Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,29]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"135","article-title":"The historical development of cancer chemotherapy","volume":"4","author":"Burchenal JH","year":"1977","journal-title":"Semin Oncol"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrc1529"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.296.12.1518"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-64-2-328"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2008.0012"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2017.08.004"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir073"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1988.00380120031007"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199305063281808"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20890"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1196\/annals.1414.035"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6605273"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.25691"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.2165\/11592980-000000000-00000"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.21847"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197105132841904"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkp074"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.2010.02340.x"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d449"},{"key":"e_1_2_9_21_1","unstructured":"Chemotherapy Services in England: Ensuring Quality and Safety.National Chemotherapy Advisory Group (NCAG) United Kingdom Department of Health.2009. Accessed May 12 2012.https:\/\/webarchive.nationalarchives.gov.uk\/20130104173757\/http:\/\/www.dh.gov.uk\/en\/Publicationsandstatistics\/Publications\/DH_104500"},{"key":"e_1_2_9_22_1","unstructured":"Clinical Oncology Information Network.Royal College of Radiologists (United Kingdom) Clinical Oncology Information Network.2008. Accessed May 12 2012.http:\/\/www.rcr.ac.uk"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdp163"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2014.0157"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-019-04961-4"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-012-1459-y"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"e_1_2_9_29_1","unstructured":"What Is RECORD? Reporting of Studies Conducted Using Observational Routinely\u2010Collected Data (RECORD) website. c2019. Accessed June 1 2021.https:\/\/www.record\u2010statement.org\/"},{"key":"e_1_2_9_30_1","volume-title":"Emergency Severity Index (ESI): A Triage Tool for Emergency Department Care, Version 4. Implementation Handbook 2012 Edition. AHRQ Publication No. 12\u20100014","author":"Gilboy N","year":"2012"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1309\/AJCPOJN03GOXZRZY"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2013.0730"},{"key":"e_1_2_9_33_1","unstructured":"National Patient Safety Goals.The Joint Commission website. c2021. Accessed September 20 2020.https:\/\/www.jointcommission.org\/standards\/national\u2010patient\u2010safety\u2010goals\/"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1701380"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1177\/0962280211427759"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.16435"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1177\/1536867X1501500208"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-032315-021402"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.091092"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1086\/590061"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.4.1306-1311.2005"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.123.5.1615"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2003.07.005"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-019-05056-w"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1188\/02.CJON.337-340"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1188\/11.ONF.661-668"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2017.026054"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1188\/11.CJON.E53-E57"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2014.002733"},{"key":"e_1_2_9_50_1","first-page":"10","article-title":"Improving the emergency department management of post\u2010chemotherapy sepsis in haematological malignancy patients","volume":"21","author":"Ko HF","year":"2015","journal-title":"Hong Kong Med J"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2010.08.011"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.12809\/hkjr1312157"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-014-2377-y"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aenj.2005.04.005"},{"key":"e_1_2_9_55_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.15-6-526"},{"key":"e_1_2_9_56_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_2_9_57_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-013-1758-y"},{"key":"e_1_2_9_58_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.57.2347"},{"key":"e_1_2_9_59_1","unstructured":"What study designs can be considered for inclusion in an EPOC review and what should they be called? Cochrane Effective Practice and Organization of Care website. 2017. Accessed June 1 2021.https:\/\/epoc.cochrane.org\/sites\/epoc.cochrane.org\/files\/public\/uploads\/Resources\u2010for\u2010authors2017\/what_study_designs_should_be_included_in_an_epoc_review.pdf"}],"container-title":["Academic Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.14335","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/acem.14335","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.14335","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T17:30:01Z","timestamp":1693243801000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acem.14335"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,29]]},"references-count":58,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,1]]}},"alternative-id":["10.1111\/acem.14335"],"URL":"https:\/\/doi.org\/10.1111\/acem.14335","archive":["Portico"],"relation":{},"ISSN":["1069-6563","1553-2712"],"issn-type":[{"value":"1069-6563","type":"print"},{"value":"1553-2712","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,29]]},"assertion":[{"value":"2021-04-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-06-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-07-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}