Factor first! Emergency department management of persons with hemophilia: a single-center study

Timely hemostatic therapy is essential when persons with hemophilia (PwH) present to the emergency department (ED), with guidelines recommending treatment at the time a bleed is suspected ('Factor First' strategy).

This study examined ED management of PwH in Southern Alberta from 2014 to 2022, focusing on adherence to guidelines.

A total of 393 ED visits from 191 adults with hemophilia A or B were identified. Most visits (86%) required emergent or urgent care. Median times from ED registration to ordering and administering hemostatic therapy were 2.9 and 4.2 hours, respectively, with treatment given within 2 hours in a minority of cases. Laboratory tests were ordered in nearly half of visits, with a median ordering time of 65 minutes. Use of individualized emergency management protocols increased over time, reaching 91.4% in 2022. Median ED stay was 3.4 hours, and approximately 25% of visits had a hemophilia-related admission diagnosis.

These findings highlight persistent delays and nonadherence to best practice recommendations, emphasizing the need for targeted quality improvement interventions to ensure timely, guideline-concordant care for PwH in emergency settings.