Increasing optimal coagulation factor dosing in the paediatric emergency department: A quality improvement study

Area of Science:

• Hematology
• Emergency Medicine
• Quality Improvement Science

Background:

• Haemophilia management involves complex factor replacement dosing, particularly in emergency settings.
• Challenges in emergency department (ED) factor dosing can impact patient care and outcomes.

Purpose of the Study:

• To reduce instances of suboptimal factor dosing in haemophilia patients within the ED.
• To increase the number of ED visits with appropriate factor dosing between suboptimal administrations.

Main Methods:

• A retrospective chart review of haemophilia A (HA) and B (HB) patients treated in the ED from September 2015 to August 2016.
• Injuries were categorized (minor/major), and optimal factor dosing was defined as 90%-120% of the guideline goal.
• Comparison of predicted optimal factor doses with actual administered doses.

Main Results:

• Baseline optimal dosing occurred in 70% of encounters.
• Quality improvement interventions initially led to 16 encounters with optimal dosing, surpassing the goal of 15.
• Sustained optimal dosing was not achieved after the intervention period.

Conclusions:

• Accurate coagulation factor dosing is critical for haemophilia patient care and healthcare resource management.
• Quality improvement initiatives can enhance the precision of factor dosing for haemophilia patients in the ED.