Implementation of an electronic registry to monitor quality of care for febrile episodes in pediatric patients with cancer in Central America and the Caribbean

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PURPOSE: Standardized quality metrics are critical to evaluate guideline adherence and outcomes, yet these are rarely tracked outside of time-limited research studies in resource-constrained settings. We describe the early implementation of the Global Fever Registry (FEVEREG), an electronic registry designed to collect local quality indicators and support implementation of a clinical guideline for fever with neutropenia in children with cancer. METHODS: Between 2021 and 2023, the registry was introduced at six referral hospitals in Central America and the Caribbean. We assessed the feasibility of a cohort-based implementation model through descriptive analysis of the duration of key implementation steps, delays in data entry, completion of required data fields, and center participation. RESULTS: Over 2 years, 619 febrile episodes from 472 children were recorded. The all-site median delay from episode onset to database entry was over 30 days, but two centers had median delays of > 4 months; one subsequently discontinued registry use. Audits at 14 and 24 months after registry activation demonstrated 89% completion of required fields at both time points. CONCLUSION: A heterogeneous group of centers successfully implemented a common registry and achieved high data completeness. However, workforce shortages and competing clinical demands contributed to intermittent registry use and delayed entry, highlighting the need for institutional investment in data management. Registry data have already informed local quality improvement projects; future work should identify factors that sustain long-term use.

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