Increasing optimal coagulation factor dosing in the paediatric emergency department: Update to a quality improvement...

Area of Science:

• Pediatric Emergency Medicine
• Hematology
• Quality Improvement Science

Background:

• Prompt and accurate coagulation factor replacement is crucial for managing injuries and bleeding in individuals with haemophilia (HA) and haemophilia B (HB).
• Inappropriate dosing can lead to acute and long-term complications, necessitating optimized treatment protocols.

Purpose of the Study:

• To increase the proportion of appropriately treated HA and HB patients in a pediatric emergency department from 65% to 85%.
• To reduce the incidence of out-of-range coagulation factor dosing during emergency department encounters.
• To increase the time interval between patient encounters with incorrect factor dosing.

Main Methods:

• Quality improvement methodology, including plan-do-study-analyze cycles, was employed.
• Audits of emergency department encounters assessed coagulation factor dosing for HA/HB patients.
• Interventions focused on improving communication through the electronic medical record and enhancing physician education.

Main Results:

• The rate of out-of-range factor dosing in emergency department encounters decreased from 33.3% to 18% after interventions.
• The mean percentage of encounters receiving optimal factor dosing (82.2%) showed an increase compared to baseline (71.1%), although not statistically significant.
• Despite improvements, out-of-range dosing still occurred in a notable proportion of cases.

Conclusions:

• Multiple interventions did not fully eliminate out-of-range factor dosing in the emergency department.
• Future plans include reinstating simulation center education and continuing educational efforts for healthcare professionals.
• The goal is to further minimize dosing errors and improve patient outcomes in emergency settings.