Early Supported Discharge for patients with febrile neutropenia - Experience at a large district hospital in the UK

Neutropenic sepsis can be life threatening, with mortality 2-21%. The heterogeneity of patients referred with "suspected neutropenic sepsis" has led to strategies being developed to risk-stratify patients and identify those with a low risk of septic complications that could be managed in the outpatient setting, such as The Multinational Association for Supportive Care in Cancer score (MASCC). Outcomes for patients referred with suspected neutropenic sepsis were assessed before and after use of MASCC guided early-supported discharge. 50/123 (41%) patients over 24 months were eligible for early-supported discharge. 26/50 patients had same-day discharge, 14 had overnight admission, 8 stayed 2 nights and 2 stayed 3 nights. Patients received on average 2 follow-up telephone consultations. There were 5 readmissions (10%) and no adverse events. In comparison group; 8 patients over 3-months would have been suitable, potentially saving 40 bed-days. This shows MASCC guided early-supported discharge is safe and cost-effective.

Evolving sepsis definitions and their impact on Acute Medical Units

BACKGROUND

There are currently several different definitions for sepsis. This study looked at what proportion of acute medical admissions were identified by the different definitions, what correlation they have, and how many patients would require a review with results in 1 hour.

METHODS

Data on 212 admissions was collected, on time of admission and review, and number of patients with sepsis by each diagnostic criteria calculated.

RESULTS

The NICE criteria identified 69% of admissions as requiring review within one hour, compared to 6% with qSOFA and 18% with previous sepsis definitions. The mean time to review was 1hr 18min, and only 50% of patients meeting the NICE criteria were reviewed within one hour.

CONCLUSIONS

The proposed NICE guidance will be challenging to implement with current resources.

Problem based review: pulmonary embolism in pregnancy

Pulmonary embolism (PE) in pregnancy carries a significant mortality. Pregnant patients often present via the acute medical take with symptoms of possible PE and require timely assessment and investigation. The symptoms of PE are sometimes very difficult to differentiate from those of normal pregnancy and the vast majority of patients will require imaging. The radiation risks to mother and foetus from imaging may cause considerable anxiety (to both patients and healthcare providers) and need to be explained to patients in the context of a potentially life-threatening condition so they can be actively involved in decision-making on how best to proceed. When PE is diagnosed in pregnancy, there are obstetric considerations around the time of delivery and women should receive specialist follow-up.