Impact of Manchester Triage on the Referral Pathway of Febrile Neutropenia Patients in the Emergency Department - A Single-Center Experience.

PURPOSE: Febrile neutropenia is a frequent complication of oncological treatment. Empirical antibiotic therapy should be started within the first hour after admission. Delays in its administration are associated with prolonged hospital stays and higher mortality rates. This study assessed the impact of Manchester Triage on time to antibiotic initiation in febrile neutropenia patients admitted to the Emergency Department (ED).

METHODS

This retrospective single-center study included adult cancer patients admitted to the ED in 2022 diagnosed with febrile neutropenia.

RESULTS

Among 38 patients, 34% were assigned an orange code and 11% a white code (referred from outpatient consultation); all in these two groups were directed to Internal Medicine (IM). A yellow triage code was assigned to 55% of patients, who were then directed either to IM or General Medicine (GM), without a defined criterion. Among patients triaged to IM (74%), the median time from admission to initiation of antibiotics was 4 h 27 min compared with 7 h 46 min for those triaged to GM (p = 0.03). There was no statistically significant correlation between time to antibiotic initiation and length of hospital stay or mortality.

CONCLUSION

Delays are significant and worsened when patients are assigned a yellow Manchester Triage code and are directed to GM. The study was underpowered to detect a statistically significant effect on mortality, but the observed mortality rate was double that reported in the literature. Proper triage of febrile oncological patients in the ED is crucial, and protocols with well-defined criteria should be implemented to ensure timely treatment.