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. Our aim was to assess the impact of Manchester Triage of febrile neutropenia patients admitted to the Emergency Department (ED) on time to antibiotic initiation. Methods: Patients with cancer admitted to the ED of our institution in 2022 who had a diagnosis of febrile neutropenia were selected. Non-oncological patients and children were excluded. Results: Out of 38 patients, 34% were assigned an orange code and 11% a white code (referred from outpatient consultation); all patients 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 4h27 (min. 1h08, max. 20h32), while for those triaged to GM (26%), the median was 7h46 (min. 3h04, max. 45h20) (p = 0.03, Mann–Whitney U). Conclusion: the data show that delays are significant and worsened when patients are assigned a yellow Manchester Triage code and are not triaged directly to IM. Proper triage of febrile oncological patients in the ED is crucial, and protocols with well-defined criteria should be implemented to ensure timely treatment.