Presentation Details
| Timeliness of Hemostatic Therapy Administration for Patients with Bleeding Disorders in the Emergency Department Emily Kraft, Vanessa Bourck, Yuxin Zhang, Lisa Duffett, Alan Tinmouth, Tzu-Fei Wang, Roy Khalife. Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada |
Abstract
Background: Patients with Bleeding Disorders (PWBD) presenting to the Emergency Department (ED) face critical health risks. Timely intervention is essential, as delays in emergency care can escalate the risk of pain, disability, anxiety, and hospital admissions, and in severe cases, may result in life-threatening outcomes. The urgency of administering hemostatic therapies is underscored by current standards and Canadian emergency room guidelines, which advocate for treatment of severe bleeding events within 30 minutes and mild-to-moderate events within 60 minutes. Despite these recommendations, adherence to these guidelines is not well documented. Objectives: This study examines adherence to these standards in emergency care for PWBD to benchmark performance measures for quality improvement initiatives. Methods: We conducted a retrospective cohort study using administrative data and chart review between June 1, 2019 and December 31, 2022. We included patients with hemophilia or von Willebrand disease presenting to our institution’s ED. We collected data on demographics, diagnosis, severity, clinical presentation, Canadian Triage and Acuity Scale (CTAS) score, hemostatic therapies, and time intervals from ED arrival to therapy administration. Data were analyzed descriptively to summarize time intervals. We used generalized linear regression models to compare time intervals with bleeding disorder diagnosis, disease severity, sex, prescriber specialty, and CTAS score. Results: Among 241 ED visits in 122 PWBD, 35.7% (86/241) were for bleeding events. Of these events, 50% (43/86) were treated with hemostatic therapies, using clotting factor concentrates (CFCs) (36/43, 83.7%) or desmopressin (7/43, 16.3%). For patients presenting with non-bleeding events, 7.7% (12/155) received CFCs and 0.6% (1/155) received desmopressin. Median CTAS score was 2 (IQR 2 – 3). The recorded median time from triage to administration of hemostatic agents was 175 minutes (min) (IQR 93 – 364) for the 48 patients receiving CFCs and 206 min (IQR 152 – 269) for the 8 patients receiving desmopressin. Additional time intervals at multiple stages are presented in Table 2. Severe bleeding disorders were associated with statistically significant longer delays from time of ED triage to therapy administration, mean 300.19 min (95% CI 216.45, 397.59), compared to milder bleeding disorders, mean 165.49 (95% CI 102.81, 243.02), p <.05. Subgroup analysis by bleeding disorders did not demonstrate statistically significant differences between disease severity and time from ED triage to therapy administration. We did not observe statistically significant differences based on prescriber specialty or CTAS score. Sex was not associated with statistically significant differences in the time from ED triage to therapy administration. However, women experienced clinically significant delays, mean 304.70 min (95% CI 166.68, 484.04), compared to men, mean 215.06 min (95% CI 155.79, 283.87), p = 0.284. Conclusion: This study revealed concerning delays observed at multiple stages underscoring a critical gap in meeting accepted standards for timely hemostatic therapy administration to PWBD in the ED setting at our institution. Delays at various stages of care signify a pressing need for educational initiatives and quality improvement strategies aimed at expediting treatment. Improving the standard of care for PWBD is paramount to mitigate pain, disability, hospital admissions, and fatalities associated with bleeding events.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.