ORIGINAL ARTICLE Compliance with a critical pathway for the management of febrile neutropenia and impact on clinical outcomes J. Zuckermann & L. B. Moreira & P. Stoll & L. M. Moreira & R. S. Kuchenbecker & C. A. Polanczyk Received: 18 July 2007 / Accepted: 14 September 2007 / Published online: 16 October 2007 # Springer-Verlag 2007 Abstract Febrile neutropenia is associated with significant morbidity and mortality. Managing infectious in neutro- penic patients remains a dynamic process, making neces- sary timely and efficient empirical antibiotic therapy. The implementation of critical pathways has been suggested as a strategy to improve clinical effectiveness. This study evaluated the compliance with an institutional critical pathway for the management of febrile neutropenia and the impact on clinical outcomes at Hospital de Clínicas de Porto Alegre, Brazil (HCPA). We performed a cohort study that prospectively included patients hospitalized from January 2004 to December 2005 and presented febrile neutropenia (190 episodes). Historical controls were select- ed from March 2001 to April 2003 (193 episodes) before the critical pathway was introduced. This study showed a low rate of full compliance (21.6%; 95% CI 15.7–27.5) with the critical pathway. In most cases, there was partial compliance (67.9%; 95% CI 61.3–74.5). Despite the moderate adherence observed, we recorded a decrease in in-hospital all-cause mortality in the sample studied after protocol implementation (from 24.4 to 14.4%; P=0.017) and reduction in the length of use of cephalosporin and quinolones. In conclusion, implementation of a critical pathway seems to be an effective strategy to improve clinical outcomes in patients hospitalized with febrile neutropenia. Keywords Critical pathway . Febrile neutropenia . Treatment guidelines . Compliance . Antibiotic policy Ann Hematol (2008) 87:139–145 DOI 10.1007/s00277-007-0390-7 DO00390; No of Pages Financial support: FIPE/HCPA (Fundo de Incentivo à Pesquisa). J. Zuckermann Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil J. Zuckermann Pharmacy and Therapeutics Committee and Pharmacy Department, Pharmaceutical Assistance Unit, Drug Information Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil L. B. Moreira Postgraduate Program in Medical Sciences, School of Medicine, Department of Pharmacology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil L. B. Moreira (*) Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350 s.947, 90.035-903 Porto Alegre, RS, Brazil e-mail: lbmoreira@hcpa.ufrgs.br P. Stoll : L. M. Moreira Scientific Initiation Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil R. S. Kuchenbecker Hospital Infection Control Committee, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil C. A. Polanczyk Postgraduate Program in Cardiology and Epidemiology, School of Medicine, Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil