Achieving Faster Bleeding Disorder Treatment in the Emergency Department: A Quality Improvement Initiative.

Introduction: People with bleeding disorders (PwBD) often rely on the emergency department (ED) for clotting factor concentrate (CFC) administration for apparent or suspected bleeding. Timely CFC administration reduces complications but is challenging due to high ED patient volumes and uncertainty about the treatment type, dose, and timing (especially in the pediatric population). Our project aimed to improve the time to CFC for PwBD presenting to the ED with bleeding concerns, with an initial SMART (specific, measurable, achievable, relevant, and time-bound) aim of decreasing the median time from 129 to 99 minutes within 6 months. Methods: Our interventions included educational initiatives, personalized management cards, improved hematology-to-ED communication, and the development of an evidence-based algorithm and guideline. Results: We exceeded our SMART aim, reducing the median time to CFC to82 minutes during the 6 months, and since then we have further improved treatment times, with a median time to CFC of 61 minutes since project initiation (53% reduction from baseline) and a median time to CFC of 41 minutes during the most recent 6 months of data collection (68% reduction from baseline). Conclusions: Our results highlight the successful and sustained application of quality improvement methodologies to improve CFC administration time in PwBD.