Optimizing Emergency Department Care for People With Bleeding Disorders: A Scoping Review of Barriers and Interventions for Improvement.

BACKGROUND

Emergency department (ED) care is critical for managing acute bleeding events in people with bleeding disorders. Despite international guidelines recommending haemostatic treatment within 30-60 min, delays and deviations from best practices are common and associated with poorer outcomes.

OBJECTIVE

Identify barriers to guideline-concordant ED management of bleeding disorders, evaluate interventions, assess clinical impact, and highlight knowledge gaps to inform future research.

METHODS

Five databases (MEDLINE, Embase, Scopus, Web of Science, Cochrane Library) were searched from inception to 21 March 2025, following established scoping review guidelines and a pre-registered protocol. Eligible studies examined barriers or interventions for improving ED care. Data were independently screened and extracted by two reviewers, then synthesized using descriptive statistics and narrative synthesis.

RESULTS

Seventeen studies out of 3541 met inclusion criteria. Common barriers included electronic medical record (EMR) limitations, absence of standardized protocols, limited healthcare professional education, and inadequate communication with haematology. Delayed time to therapy (n = 8, range 1.4-5.6 h) was frequently reported; additional impacts included failure to administer haemostatic therapy for confirmed/suspected bleeding, non-indicated diagnostic testing, and patient mortality. Most interventions combined EMR enhancements with education. All interventions were associated with improved outcomes, including reduced time to therapy (n = 4, range 0.4-2.5 h). Perspectives of people with bleeding disorders and caregivers were infrequently incorporated.

CONCLUSION

This review provides the first comprehensive synthesis of barriers and interventions in ED care for people with bleeding disorders, identifying critical gaps in timely treatment, interdisciplinary coordination, and stakeholder engagement. These findings provide a foundation for future quality improvement research.