{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:08:35Z","timestamp":1785409715647,"version":"3.56.0"},"reference-count":29,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"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"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Persons with bleeding disorders (PwBD) frequently experience delays to haemostatic therapy in emergency departments (EDs). Identifying clinician knowledge gaps and workflow barriers is essential to accelerate time\u2010to\u2010treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To define educational needs and system constraints shaping the evaluation and management of PwBD in Canadian EDs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an exploratory, sequential mixed\u2010methods study. An online survey of ED nurses and physicians, distributed via national organizations, used four clinical vignettes to probe triage, diagnostic approach, initial management, and self\u2010rated knowledge; quantitative data were summarized descriptively. Virtual focus groups then explored barriers and solutions and were analyzed using reflexive thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Three hundred ten clinicians completed the survey (250 nurses; 60 physicians). Most reported prior PwBD experience, but fewer had administered specialized haemostatic products. Across vignettes, respondents assigned high acuity and endorsed a \u226430\u2010min treatment target, yet empiric \u201ctreat\u2010first\u201d therapy was inconsistently selected, particularly for non\u2010specific presentations (severe headache, abdominal pain, early pregnancy bleeding). Reported gaps included use of haemostatic therapies; interpretation of coagulation assays; inhibitor management; and limited familiarity with treatment pathways. Barriers included absence of medical directives, treatment release processes, staffing and crowding pressures, and rural resource constraints. Six focus groups (nurses\n                      <jats:italic>n<\/jats:italic>\n                      = 10; physicians\n                      <jats:italic>n<\/jats:italic>\n                      = 4) explained these patterns, revealing a pathway from high perceived acuity to delayed treatment through intersecting knowledge, scope, and system factors, alongside strong preference for concise, point\u2010of\u2010care education, simulation, and web\u2010based learning.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Co\u2010designed education, nurse\u2010initiated directives, streamlined product release, and accessible point\u2010of\u2010care tools are complementary levers to compress triage\u2010to\u2010therapy intervals for PwBD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hae.70365","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:51:12Z","timestamp":1785408672000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Why \u201cTreat First\u201d Stalls: Knowledge, Scope, and System Determinants of Delayed Haemostatic Therapy in the Emergency Department"],"prefix":"10.1111","author":[{"given":"Emily","family":"Kraft","sequence":"first","affiliation":[{"name":"Faculty of Medicine University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Cowley","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute The Ottawa Hospital  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Bourck","sequence":"additional","affiliation":[{"name":"The Ottawa Hospital  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"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haowei (Linda)","family":"Sun","sequence":"additional","affiliation":[{"name":"Division of Hematology Department of Medicine University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calvin","family":"Kruger","sequence":"additional","affiliation":[{"name":"Faculty of Nursing University of Alberta  Edmonton Alberta Canada"},{"name":"Alberta Health Services  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren J.","family":"Cheung","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute The Ottawa Hospital  Ottawa Ontario Canada"},{"name":"Department of Emergency Medicine University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Humphrey\u2010Murto","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute The Ottawa Hospital  Ottawa Ontario Canada"},{"name":"Department of Innovation in Medical Education University of Ottawa  Ottawa Ontario Canada"},{"name":"Department of Medicine (Rheumatology) University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy","family":"Khalife","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute The Ottawa Hospital  Ottawa Ontario Canada"},{"name":"Department of Medicine (Hematology) University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/hae.13956"},{"key":"e_1_2_12_3_1","unstructured":"J.Hanley M.Mathias E.Franklin et\u00a0al. \u201cEmergency and out of hours care for patients with bleeding disorders \u2013 Standards of care for assessment and treatment \u201d (2009) https:\/\/www.ukhcdo.org\/wp\u2010content\/uploads\/2015\/12\/EmergencyCareStandardsFinalVersionJune2009\u2010For\u2010Website.pdf."},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102516.2011.02721.x"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102516.2007.01625.x"},{"key":"e_1_2_12_6_1","unstructured":"National Hemophilia Foundation Medical and Scientific Advisory Council. \u201cGuidelines for Emergency Department Management of Individuals With Hemophilia and Other Bleeding Disorders (MASAC Document 257) \u201d (National Hemophilia Foundation 2019) https:\/\/www.bleeding.org\/sites\/default\/files\/document\/files\/257.pdf."},{"key":"e_1_2_12_7_1","unstructured":"Canadian Association of Emergency Physicians. \u201cThe Canadian Triage and Acuity Scale Combined Adult\/Paediatric Education Program Participant's Manual \u201d (Canadian Association of Emergency Physicians (CAEP) 2013) 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