Improving Time to Bleeding Disorder Treatment in the Emergency Department

Knowledge of the guidelines for treating people with bleeding disorders (PwBD) is vital for emergency department (ED) staff, as PwBD rely on the ED for treatment of acute bleeding episodes or injuries. Unfamiliarity with these guidelines can delay treatment. We aimed to improve the timely treatment of PwBD seeking emergency care by reducing the mean time-to-factor administration in the ED by 20%, from the baseline of 110 to 88 minutes.

Our quality improvement (QI) initiative (2019-2024) used Plan-Do-Study-Analyze cycles. Weekly electronic health record (EHR) reports tracked PwBD's time of arrival, admission, clotting factor concentrate ordering, and administration. Interventions targeted delays identified in the process.

Baseline data showed a 110-mean time-time-to-factor. Our aim of reducing the time-to-factor by 20% from the baseline of 110 minutes was reached in May 2020. This improvement was exceeded and sustained throughout the project. At the conclusion, we achieved a 62% reduction in time-to-factor and a mean time-to-factor of 42 minutes.

By using an EHR tool, we were able to identify when during the ED visit process delays occurred, which helped us better target our interventions. Our educational-based interventions were adapted to reach our intended audiences while working around barriers related to the COVID-19 pandemic, such as high patient volumes and staff shortages. Our results show a decrease in time to factor in the ED and an increase in the PwBD receiving factor within 60 minutes of arrival time. This has been a sustainable improvement.