Pediatric patients with bleeding dyscrasias: what is the cause of delays in initiating replacement therapy?
BACKGROUND
The objectives of this study were to (a) evaluate the emergency department management of pediatric patients with bleeding disorders, specifically regarding time intervals from triage to administration of replacement therapy, and (b) to review resultant patient outcomes.


METHODS
A retrospective review was performed of charts from June 1996 to June 1998 for all patients with known bleeding disorders whose course was followed by the hematology clinic. Records were reviewed for all emergency department visits that required replacement therapy. Time intervals from triage to initiation of therapy were evaluated.


RESULTS
Eleven of 24 patients required administration of factor or desmopressin acetate. The mean time from triage to therapy administration was 103 minutes (range, 7 to 175 minutes; SD +/- 38). The mean time from triage to placement in a room was 34.3 minutes (SD +/- 32.6). The mean time to order replacement therapy was 26.7 minutes (SD +/- 27.4). The mean time from physician evaluation to administration of replacement therapy was 34.2 minutes (SD +/- 15.9). These intervals were believed to be suboptimal, and a new nursing driven protocol was established to expedite patient care.


CONCLUSIONS
Simple delays in time to replacement therapy may result in increased patient morbidity. We present an easy-to-follow algorithm that can be implemented to expedite the care of pediatric patients with a known bleeding disorder.
Sharieff
G Q
GQ
Department of Emergency Medicine, University of California-San Diego Medical Center, San Diego, CA, USA.
Trocinski
D R
DR
Thompson
K
K
D000465:Algorithms; D002140:California; D002648:Child; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D004636:Emergency Service, Hospital / Q000592:standards*; D006474:Hemorrhagic Disorders / Q000175:diagnosis / Q000188:drug therapy*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D009731:Nursing Audit; D012189:Retrospective Studies; D013997:Time Factors; D014218:Triage
D006490:Hemostatics; D003894:Deamino Arginine Vasopressin