Expert review of hematology · 2025
Factor first! Emergency department management of persons with hemophilia: a single-center study.
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Uminski Kelsey, Rydz Natalia, Goodyear Dawn
Аннотация
BACKGROUND: Timely hemostatic therapy is essential when persons with hemophilia (PwH) present to the emergency department (ED), with guidelines recommending treatment at the time a bleed is suspected ('Factor First' strategy).
RESEARCH DESIGN AND METHODS: This study examined ED management of PwH in Southern Alberta from 2014 to 2022, focusing on adherence to guidelines.
RESULTS: A total of 393 ED visits from 191 adults with hemophilia A or B were identified. Most visits (86%) required emergent or urgent care. Median times from ED registration to ordering and administering hemostatic therapy were 2.9 and 4.2 hours, respectively, with treatment given within 2 hours in a minority of cases. Laboratory tests were ordered in nearly half of visits, with a median ordering time of 65 minutes. Use of individualized emergency management protocols increased over time, reaching 91.4% in 2022. Median ED stay was 3.4 hours, and approximately 25% of visits had a hemophilia-related admission diagnosis.
CONCLUSIONS: These findings highlight persistent delays and nonadherence to best practice recommendations, emphasizing the need for targeted quality improvement interventions to ensure timely, guideline-concordant care for PwH in emergency settings.
RESEARCH DESIGN AND METHODS: This study examined ED management of PwH in Southern Alberta from 2014 to 2022, focusing on adherence to guidelines.
RESULTS: A total of 393 ED visits from 191 adults with hemophilia A or B were identified. Most visits (86%) required emergent or urgent care. Median times from ED registration to ordering and administering hemostatic therapy were 2.9 and 4.2 hours, respectively, with treatment given within 2 hours in a minority of cases. Laboratory tests were ordered in nearly half of visits, with a median ordering time of 65 minutes. Use of individualized emergency management protocols increased over time, reaching 91.4% in 2022. Median ED stay was 3.4 hours, and approximately 25% of visits had a hemophilia-related admission diagnosis.
CONCLUSIONS: These findings highlight persistent delays and nonadherence to best practice recommendations, emphasizing the need for targeted quality improvement interventions to ensure timely, guideline-concordant care for PwH in emergency settings.