{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T22:24:57Z","timestamp":1785450297256,"version":"3.56.0"},"reference-count":11,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,12,25]],"date-time":"2023-12-25T00:00:00Z","timestamp":1703462400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Haemophilia"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Prompt, appropriate coagulation factor replacement according to injury and bleeding severity in persons with haemophilia is required to prevent acute and long\u2010term complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>Increase proportion of persons with haemophilia A (HA) and B (HB) treated appropriately for an acute injury and bleeding episode at a tertiary children's emergency department (ED) from 65% to 85% and sustain for one year. Secondary aim: increase time interval between patient ED encounters with out\u2010of\u2010range factor dosing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Utilizing quality improvement methodology and plan\u2010do\u2010study\u2010analyze cycles, ED encounters for individuals with HA\/HB receiving coagulation factor replacement for injuries were audited for in\u2010range coagulation factor dosing. Goal factor dose defined as 50% correction for minor bleeds and 100% correction for major bleeds. Optimal dosing range defined as 90%\u2013120% of the calculated goal dose to account for vial size variability. Interventions targeted communication via the EMR problem list and optimization of physician education.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Our previous publication demonstrated 33.3% of ED encounters with out\u2010of\u2010range factor replacement. Following several interventions, the cumulative rate of encounters with out\u2010of\u2010range dosing decreased to 18%. Overall, there was an increase in the mean percent of encounters receiving optimal factor dosing for both HA\/HB compared to baseline (82.2% vs. 71.1%), though this was not a statistically significant difference.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite implementation of multiple interventions, out\u2010of\u2010range factor dosing continues to occur. Our team plans to reinstate simulation center education for ED staff and continue education efforts of pharmacists and hematology trainees with the goal of further reducing out\u2010of\u2010range dosing in our ED.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hae.14927","type":"journal-article","created":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T07:54:16Z","timestamp":1703577256000},"page":"367-374","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Increasing optimal coagulation factor dosing in the paediatric emergency department: Update to a quality improvement study"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8374-6438","authenticated-orcid":false,"given":"Nicole E.","family":"Kendel","sequence":"first","affiliation":[{"name":"Division of Pediatric Hematology\/Oncology Nationwide Children's Hospital  Columbus Ohio USA"},{"name":"Department of Pediatric Hematology\/Oncology Akron Children's Hospital  Akron Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman","family":"Abdelghani","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology\/Oncology Nationwide Children's Hospital  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph R.","family":"Stanek","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology\/Oncology Nationwide Children's Hospital  Columbus Ohio USA"},{"name":"Biostatistics Resource at Nationwide Children's Hospital  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brockton","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology\/Oncology Nationwide Children's Hospital  Columbus Ohio USA"},{"name":"Quality Improvement Resource at Nationwide Children's Hospital  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W.","family":"Dunn","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine Nationwide Children's Hospital  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vilmarie","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology\/Oncology Nationwide Children's Hospital  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy L.","family":"Dunn","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology\/Oncology Nationwide Children's Hospital  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,12,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0031-1297164"},{"key":"e_1_2_10_3_1","unstructured":"MASAC.Guidelines for emergency department management of individuals with hemophilia and other bleeding disorders.2019. Accessed May 2023. Accessed.https:\/\/www.hemophilia.org\/Researchers\u2010Healthcare\u2010Providers\/Medical\u2010and\u2010Scientific\u2010Advisory\u2010Council\u2010MASAC\/MASACRecommendations\/Guidelines\u2010for\u2010Emergency\u2010Department\u2010Management\u2010of\u2010Individuals\u2010with\u2010Hemophilia"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/hae.14046"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2007.12.024"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.medcli.2021.04.031"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation-2015.1.26"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/hae.13693"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/NCQ.0000000000000448"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.afjem.2020.07.001"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2013.001114"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpag.2018.11.002"}],"container-title":["Haemophilia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hae.14927","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,30]],"date-time":"2024-04-30T02:08:29Z","timestamp":1714442909000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hae.14927"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,25]]},"references-count":11,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1111\/hae.14927"],"URL":"https:\/\/doi.org\/10.1111\/hae.14927","archive":["Portico"],"relation":{},"ISSN":["1351-8216","1365-2516"],"issn-type":[{"value":"1351-8216","type":"print"},{"value":"1365-2516","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,25]]},"assertion":[{"value":"2023-08-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-12-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-12-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}