The development and implementation of an integrated clinical decision pathway (CDP) for febrile neutropenia care across a large, multi-site cancer center network improved standardization, facilitated risk-adapted management, and reduced patient hospital admissions. 

This research was presented by Marianne J. Davies, DNP, ACNP, AOCNP, FAAN, Smilow Cancer Hospital at Yale, New Haven Connecticut, at the 2025 Journal of the Advanced Practitioner in Oncology (JADPRO) meeting in National Harbor, Maryland.

Despite the availability of national clinical practice guidelines, existing tools lacked integration into the electronic medical record (EMR) and were not tailored to institutional workflows. Variability in antibiotic selection, diagnostic workup, and triage decisions often led to prolonged evaluations, increased hospitalizations, longer length of stay, and unnecessary antibiotic exposure among patients.

To address these gaps, an APP-led clinical consensus group (CCG), which was comprised of APPs, physicians, nurses, pharmacists, infectious disease specialists, met biweekly over a 6-month period to develop distinct inpatient and ambulatory CDPs for patients with solid tumors and hematologic malignancies. The initiative was led by advanced practice providers (APPs) and a General Cancer Council (GCC) across 5 hospitals and 15 ambulatory centers.

The febrile neutropenia CDPs developed included, risk-stratified algorithms for inpatient versus ambulatory management, pre-built EMR order sets for antibiotics and blood cultures, integration of referral workflows to oncology urgent care, emergency departments and subspecialists, embedded diagnostic order sets and patient education tools, and links to national guidelines for reference at the point of care.

At initial assessment, the pathways had been used 2,417 times by 551 providers, impacting the care of 611 patients. Early feedback from cancer center staff indicated improved care coordination, greater adherence to evidence-based standards, and increased comfort with outpatient management of low-risk patients.

The researchers concluded, “Utilizing these CDPs leads to improved workflow, timely evaluation, decreased admissions, length-of-stay and prolonged antibiotic exposure; hence improving overall patient outcomes by standardizing care.”

Source:

Davies M, Mason K, Amendola R. Standardizing the Management of Neutropenic Fever Across a Large Comprehensive Cancer Center Utilizing Clinical Decision Pathways. Presented at the 2025 Journal of the Advanced Practitioner in Oncology Meeting. October 23-26, 2025; National Harbor, Maryland. Abstract JL1342C.