{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T10:13:25Z","timestamp":1789812805219,"version":"4.0.1"},"reference-count":27,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Haemophilia"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Emergency department (ED) care is critical for managing acute bleeding events in people with bleeding disorders. Despite international guidelines recommending haemostatic treatment within 30\u201360\u00a0min, delays and deviations from best practices are common and associated with poorer outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Identify barriers to guideline\u2010concordant ED management of bleeding disorders, evaluate interventions, assess clinical impact, and highlight knowledge gaps to inform future research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Five databases (MEDLINE, Embase, Scopus, Web of Science, Cochrane Library) were searched from inception to 21 March 2025, following established scoping review guidelines and a pre\u2010registered protocol. Eligible studies examined barriers or interventions for improving ED care. Data were independently screened and extracted by two reviewers, then synthesized using descriptive statistics and narrative synthesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventeen studies out of 3541 met inclusion criteria. Common barriers included electronic medical record (EMR) limitations, absence of standardized protocols, limited healthcare professional education, and inadequate communication with haematology. Delayed time to therapy (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a08, range 1.4\u20135.6\u00a0h) was frequently reported; additional impacts included failure to administer haemostatic therapy for confirmed\/suspected bleeding, non\u2010indicated diagnostic testing, and patient mortality. Most interventions combined EMR enhancements with education. All interventions were associated with improved outcomes, including reduced time to therapy (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a04, range 0.4\u20132.5\u00a0h). Perspectives of people with bleeding disorders and caregivers were infrequently incorporated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This review provides the first comprehensive synthesis of barriers and interventions in ED care for people with bleeding disorders, identifying critical gaps in timely treatment, interdisciplinary coordination, and stakeholder engagement. These findings provide a foundation for future quality improvement research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hae.70334","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T07:29:39Z","timestamp":1781508579000},"page":"1135-1159","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing Emergency Department Care for People With Bleeding Disorders: A Scoping Review of Barriers and Interventions for Improvement"],"prefix":"10.1111","volume":"32","author":[{"given":"Ling\u2010Yi","family":"Guo","sequence":"first","affiliation":[{"name":"Department of Medicine University of Calgary  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane L.","family":"Lorenzetti","sequence":"additional","affiliation":[{"name":"Health Sciences Library University of Calgary  Calgary Alberta Canada"},{"name":"Department of Community Health Sciences University of Calgary Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Rydz","sequence":"additional","affiliation":[{"name":"Division of Hematology and Hematologic Malignancies University of Calgary  Calgary Alberta Canada"},{"name":"Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn","family":"Goodyear","sequence":"additional","affiliation":[{"name":"Division of Hematology and Hematologic Malignancies University of Calgary  Calgary Alberta Canada"},{"name":"Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Hews\u2010Girard","sequence":"additional","affiliation":[{"name":"Faculty of Nursing University of Calgary  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garrick","family":"Mok","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy","family":"Khalife","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute  Ottawa Ontario Canada"},{"name":"Division of Hematology Department of Medicine University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelsey","family":"Uminski","sequence":"additional","affiliation":[{"name":"Division of Hematology and Hematologic Malignancies University of Calgary  Calgary Alberta Canada"},{"name":"Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"National Hemophilia Foundation.MASAC Document 257 \u2010 Guidelines for Emergency Department Management of Individuals With Hemophilia and Other Bleeding Disorders.2019.National Hemophilia Foundation."},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2007.12.024"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/hae.14046"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)02139-1"},{"key":"e_1_2_11_6_1","first-page":"s126","article-title":"Economic Costs of Hemophilia and the Impact of Prophylactic Treatment on Patient Management","volume":"22","author":"Chen S.\u2010L.","year":"2016","journal-title":"American Journal of Managed Care"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2516.2011.02721.x"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0036-1571312"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0891-5245(01)07830-0"},{"key":"e_1_2_11_10_1","article-title":"Management of Patients With Bleeding Disorders and Educational Needs Regarding Hemophilia a in 23 Italian Emergency Departments\u2014Results From a Survey Conducted in Piedmont","volume":"93","author":"Pollio B.","year":"2022","journal-title":"Acta Bio\u2010Medica?: Atenei Parmensis Italy"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/hae.13956"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.2147\/JMDH.S35272"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/1364557032000119616"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.11124\/JBIES-20-00167"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.7326\/M18-0850"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V124.21.2825.2825"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1053\/ajem.2002.30098"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/hae.14927"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.31570"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/emp2.13168"},{"key":"e_1_2_11_21_1","first-page":"106","article-title":"Hemophiliacs' Management in an Emergency Department: A 7\u2010Years Survey to Identify Areas for Safety and Quality Improvement","volume":"24","author":"Hoang M.","year":"2018","journal-title":"Haemophilia"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/MBC.0000000000001399"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2023-183055"},{"key":"e_1_2_11_24_1","first-page":"s537","article-title":"Management of Hemophilic Patients in the Emergency Setting: Assessing the Impact of a Diagnostic and Therapeutic Algorithm in a Pediatric Emergency Department","volume":"21","author":"Bertoni E.","year":"2023","journal-title":"Blood Transfusion Netherlands: Edizioni SIMTI"},{"key":"e_1_2_11_25_1","first-page":"20","article-title":"Quality Improvement Initiative Involving Electronic Health Records to Improve the Safety of Bleeding Disorder Patients in the Emergency Department","volume":"30","author":"Hodgson N.","year":"2024","journal-title":"Haemophilia"},{"key":"e_1_2_11_26_1","first-page":"46","volume-title":"Emergency and Out\u2010of\u2010Hours Care for Patients With Bleeding Disorders: An Improvement Journey at a Large Paediatric Haemophilia Comprehensive Care Centre","author":"Patel J.","year":"2020"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2018.10.034"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-010-0319-7"}],"container-title":["Haemophilia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hae.70334","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/hae.70334","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hae.70334","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T09:42:05Z","timestamp":1789810925000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hae.70334"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,15]]},"references-count":27,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/hae.70334"],"URL":"https:\/\/doi.org\/10.1111\/hae.70334","archive":["Portico"],"relation":{},"ISSN":["1351-8216","1365-2516"],"issn-type":[{"value":"1351-8216","type":"print"},{"value":"1365-2516","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,15]]},"assertion":[{"value":"2026-06-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}