Aim: To understand the feasibility of implementing an ambulatory low-risk febrile neutropenia program in a regional Victoria hospital by retrospectively evaluating historical patients who may be suitable for an ambulatory program for safety and cost effectiveness.
Methods: Historical patients with solid organ malignancy who were undergoing cytotoxic systemic therapy between 1 September 2022 to 31 August 2023 were selected from medical records and retrospectively assessed for suitability for an ambulatory low-risk febrile neutropenia program. Clinical outcomes including related complications, mortality and impact on anti-cancer therapy from the patients’ febrile neutropenic episode were evaluated, stratified by eligibility for the ambulatory program. Cost-savings from caring for the eligible patients on the ambulatory program compared to inpatient care were estimated based on length of hospital stay. Implications of implementing such program in a regional setting were discussed.
Results: 26 historical patients were retrospectively assessed for eligibility of the ambulatory program. 18 patients were considered low-risk and eligible. None of the patients in the low-risk group had directly related complications or deaths. The average length of hospital stay was 4.4 days. Eight patients were considered high-risk and not eligible for the ambulatory program. Four patients had sepsis, three did not develop directly related complications, and there was one death. The average length of stay was 12.5 days. The estimated potential cost-savings of caring for the 16 eligible patients on the ambulatory program was $78,000.
Conclusions: The retrospective analysis suggests that it is feasible to safely and appropriately select patients into an ambulatory low-risk febrile neutropenia program, with potential cost-savings for the hospital. It is important to consider the geographical distribution and vulnerability of regional populations. Successful implementation of the program in the region will likely require the main regional hospital to engage and support the participation from other subregional health services.