Emergency and out of hours care of patients with inherited bleeding disorders

Abstract

Recently, the United Kingdom Haemophilia Centre Doctors Organisation published recommendations for the standard of care for assessment and treatment of patients with bleeding disorders in the emergency department (A&E). An audit was undertaken to compare the level of care to the acceptable standards in a tertiary hospital A&E, attached to a haemophilia comprehensive care centre. A&E attendances were found by cross referencing all patients with known bleeding disorders against the EDMS attendance system. Visits from the past 3 years were identified to produce sufficient data and electronic notes from these visits were then accessed, and marked against the proforma. Data were available from 45 of a total of 54 patients, who had a total of 75 emergency visits documented. In all aspects of care, the standards were not adequately met including the average length of time between booking and clinical assessment, early initiation of specific haemostatic treatment, seeking haematology advice and arrangement of follow-up. Also no specialist clotting investigations were done with only 9/11 patients admitted having their haematological diagnosis recorded. In addition, only very few patients had the severity of bleeding disorder noted and less than half their first line treatment documented. There were significant differences in the standard of care for haemophilia patients provided by the A&E department when compared with acceptable standards. Measures have been put in place and policies have been drafted to improve this situation and provide the best possible care to persons with haemophilia.

Principles of haemophilia care: The Asia‐Pacific perspective

“…Lack of experience and knowledge of haemophilia management among healthcare workers (HCW) particularly in emergency departments can lead to serious iatrogenic complications . HTCs in Asia‐Pacific should develop protocols for emergency care that include management of serious acute complications such as intracranial haemorrhage, other major internal haemorrhage and trauma in PWH including those with inhibitors.…”

“…Lack of experience and knowledge of haemophilia management among healthcare workers (HCW) particularly in emergency departments can lead to serious iatrogenic complications. 50…”

Models for institutional and professional accreditation of haemophilia centres in Italy

“…The optimal health care of patients with haemophilia is certainly influenced by round‐the‐clock availability at the HC of both a physician expert in bleeding disorders and access to coagulation laboratories (see for details Level 2 HCs requirements 2 and 3 in Table ). It also depends on other factors that may play a role in the emergency management of patients, such as for instance clinical protocols, triage criteria assignment, transportation to specialized hospital and training . These factors should be controlled and managed by specific protocols adopted by the responsible authorities that in Italy are the Regional and Local Health Authorities.…”

Potential for development of haemophilia link nurse role within UK hospitals

“…A recent UK audit assessed emergency care in a tertiary hospital A&E, attached to a haemophilia comprehensive care centre. It identified 54 patients, of whom 45 were documented as visiting with an emergency on 74 occasions . Booking in times were documented in only 71 visits, while UKHCDO advice regarding triage within 15 min was followed with just seven patients (9.6%).…”