Electronic medical record alert in patients with hemophilia at a teaching hospital emergency department

Fernández-Mosteirín, N. (Universidad de Zaragoza) ; Calvo Villas, J.M. (Universidad de Zaragoza)

Resumen: P157
Introduction: Patients with hemophilia are often not treated appropriately when they present out-of-hours to an emergency department (ED). Delays in replacement therapy can affect morbi- mortality. Clinical decision support systems include electronic medical record alerts (EMRA) and guidelines that assist in diagnosis and treatment.
Aim: Audit the computerized automated alert tool in the electronic medical record in order to notify the need of health care provision of hemophilia patients in ED.
Methods: Retrospective review (February 2015- March 2019) of health care alert notification emails regarding of hemophilia patients in our centre, received and generated by computer alert in the electronic medical record of the ED.
Results: 164 visits to ED were registered, corresponding to 39 (37.5%) of the 104 hemophilia patients (pts) from our center. 28 of 80 pts with hemophilia A (HA) and 11 of 24 pts with HB. Median age 25 years (range: 5- 67). 31 were adults (median 33 years; range: 15-67) and 8 children under 15 (range 5- 14). Distribution by type and severity: HA: severe 9, moderate 2, mild 17; HB: severe 8, moderate 1, mild 2. 16 were under prophylaxis and 23 on demand. 11 went once to ED, 9 twice, 5 pts 3 times and 14 (36.6%) >5 times (5 with associated comorbidities). Causes for consultation (59 due to trauma and 57 directly related to hemophilia): Cutaneous/muscle bleed 18 episodes (Iliopsoas 5, cutaneous 5, other muscle 8), Joint pain 38 (bleed 8, synovitis 5, sprain 6, contusion 9, knee pain 2, post- traumatic fracture 3, nonspecific pain 5), abdominal pain 14 (gastroenteritis 5, gastrointestinal bleed 4, inguinal hernia 1, nonspecific pain 4), traumatic incise wound 4, infection 14, treatment administration 15, gingivorrhagia 7, colic pain/hematuria 7, toothache 4, allergic skin reaction 4, epistaxis 3, head trauma 2 and other causes not related to hemophilia 34 episodes. 23 hospital admissions were made in16 pts. The average length of stay of all patients admitted to ED was 4.8 hours as opposed to 2.4 hours (range: 0.1- 44.3) in hemophiliacs.
Discussion/Conclusion: In our experience, only one third of patients consult with symptoms related to hemophilia at ED. The reason for hospital admission is mostly associated to other comorbidities. EMRA system allows early care provision, better compliance with the healthcare protocol, and shorten the length of stay and reducing morbidity in hemophilia patients.

Idioma: Inglés

DOI: 10.1111/hae.13911

Año: 2020

Publicado en: HAEMOPHILIA 26, S2 (2020), P157 [108-109]
ISSN: 1351-8216

Originalmente disponible en: Texto completo de la revista

Factor impacto JCR: 4.287 (2020)

Categ. JCR: HEMATOLOGY rank: 27 / 76 = 0.355 (2020) - Q2 - T2

Factor impacto SCIMAGO: 1.213 - Genetics (clinical) (Q1) - Medicine (miscellaneous) (Q1) - Hematology (Q1)

Tipo y forma: Congress (Published version)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)