title: A Web Site to Improve Management of Patients with Inherited Bleeding Disorders in the Emergency Department: Results at 2 Years.
abstract: Treatment of patients with inherited bleeding disorders (PWIBD) in the emergency department (ED) is challenging. In 2010, a project was started involving all eight hemophilia centers (HC) and all 44 EDs of the Region of Emilia-Romagna (Italy) to improve emergency care for PWIBD. The project incorporates guidelines for emergency treatment, education for ED staff, and a dedicated Web site providing extensive information, proposing treatments, and sharing data with patients' electronic clinical records. A Web algorithm, accessible to PWIBD as well as ED and HC staff, suggests the first dose of concentrate for each type and severity of bleed or trauma. Following training courses in each ED, the network was activated. During 2012 and 2013, the site was visited 14,000 times, the EDs accessed the Web site 1,739 times, and used the algorithms 206 times. In two reference EDs, triage-assessment and triage-treatment times were reduced in 2013 and 2012 (27/20 and 110/71.5 minutes, respectively) and medical advice from the HC increased (54 vs. 24% cases). The main advantages of this system are better management of patients in ED (shorter triage-to-treatment times) and improved collaboration between HCs and EDs. The most critical point remaining is staff turnover in EDs, necessitating continual training.
authors.affiliation: Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy.
authors.forename: Annarita
authors.initials: A
authors.lastname: Tagliaferri
authors.affiliation: Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Di Perna
authors.affiliation: Haemophilia Centre of Cesena, Cesena, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Biasoli
authors.affiliation: Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy.
authors.forename: Gianna Franca
authors.initials: GF
authors.lastname: Rivolta
authors.affiliation: Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Quintavalle
authors.affiliation: Emergency Department, University Hospital of Parma, Parma, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Cervellin
authors.affiliation: Emergency Department, Hospital of Cesena, Cesena, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Barozzi
authors.affiliation: Haemophilia Centre of Cesena, Cesena, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Benedettini
authors.affiliation: Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Pattacini
mesh_terms: D000465:Algorithms; D004502:Education, Medical, Continuing; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006467:Hemophilia A / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D020407:Internet; D007558:Italy; D008297:Male; D016347:Medical Records Systems, Computerized