Timeliness of hemostatic therapy administration for patients with bleeding disorders in the emergency department

Persons with bleeding disorders (PwBD) often face delays in receiving hemostatic therapies within the recommended 60-min window upon presenting to the emergency department, potentially exacerbating their conditions. We aimed to investigate the emergency department workflow for managing PwBD to identify inefficiencies and barriers to timely treatment. We conducted a retrospective cohort study of patients with hemophilia and von Willebrand disease (VWD) presenting to the emergency department from 2019 to 2022. Data were collected on patient demographics, disease type, severity, treatment type, and prescriber specialty. Time from triage to medication administration was the primary outcome. Statistical comparisons and Firth's penalized logistic regression were performed. Among 241 emergency department visits in 122 PwBD, 50% of the 86 bleeding events were treated with hemostatic therapies. Only 11% received them within 60 min. The median time from emergency department triage to administration of hemostatic therapies was 175 min [interquartile range (IQR) 93-364] for clotting factor concentrates (CFCs) and 206 min (IQR 152-269) for desmopressin. Important delays were observed in patient rooming, physician initial assessment, ordering and administration of hemostatic therapies. Patients triaged more urgently may have experienced higher odds of receiving hemostatic therapies in 60 min or less, though regression analysis did not identify statistically significant predictors of treatment beyond 60 min. This study highlights the urgent need for targeted interventions to address systemic challenges and mitigate treatment delays for PwBD in Canadian emergency department settings. Future research should focus on prospective evaluations of intervention effectiveness and the role of patient self-management in reducing emergency department dependency.