An off-hours bleed for an adult with moderate to severe haemophilia, from the first sensation to recovery, mapped from two patient interviews and a haemophilia nurse.
Stage 0
Symptom onset
A warmth, a tightness, a red toilet bowl. On a target joint he knows before it shows. Anywhere else, he does not.
Minimum viable care loop, off-hours
Office hours
Current behaviours
Emotions
Pain
Opportunity
1
Off-hours triage and severity
"Is it a bleed? Is this serious?"
2
Acute decision and treatment First decision
"What should I do?"
3
The 24 hours after the dose Second decision
"Is the treatment working, and what's next after factor?"
4
Post-bleed recovery
"Am I safe to return to normal activity?"
Current behavioursActivity Traceback Recall activity over 24-48 hours Correlate sensation with recent activity Scale Severity Determine bleed type: spontaneous or trauma Identify bleed site Evaluate range of motion Assess pain intensity, visible signs Verify unfamiliar bleeds via search
Current behavioursChoose path: Self-manage or visit A&E. Route directly: Go to SGH, NUH, or KKH. Determine dose: Use memory and severity matrix. Self-infuse factor: Single dose for prophylaxis/bleed. Risk waiting: Delay infusing overnight to avoid burden. Apply adjunctive care: Use RICE and tranexamic acid.
Current behavioursPost-Infusion Monitoring: Guess if bleeding stopped, subjectively Assess need for 2nd dose or A&E Redose if symptoms persist Try reaching nurse (often fails after hours) Fall back on WhatsApp, web, memory *Familiar bleeds: step often skipped
Current behavioursInconsistent bleed reporting: Nurse updates often skipped for self-managed target joint bleeds. Monitor recovery: Track pain and joint mobility. Low physio uptake: Skipping formal rehab sessions. Pause activity: Rest joints 1-2 weeks. Trial-and-error return: Unguided physical activity resumption.
Self-dose:-1(late-night groggy) / eased by pre-set dose
Emotions
-3(unusual bleed) / skipped for familiar
Emotions
+1acute relief /-2recovery "gray zone"
PainUncertain if symptom is a bleed off-hours Uncertainty delays time-to-infusion Fear of missing high-risk bleeds Root cause: no off-hours decision support; Can't distinguish arthropathy, strain, bleed aura
PainDosing confusion: Prophylaxis versus treatment dose. Contraindicated meds: High risk taking NSAIDs for blood in urine. Tedious infusion: Nine vials, difficult vein access. Delay treatment overnight: Sleep through to avoid infusion error and burden. Root cause: Lacks intuitive, site-specific rules. No clear clinical "don'ts."
PainNo After-Hours Point of Contact Re-dosing ambiguous WFH guide buried in long PDF WhatsApp advice subjective, bleeds go unlogged Some hospitals lack dedicated HCP contact Root cause: no post-infusion feedback loop
OpportunityGuided Site-specific triage + severity-scaling aid Familiar vs unfamiliar symptom prompts Risk indicators
OpportunityEscalation decision-aid with clear thresholds Patient-specific care plan: Personalised dose reference (which dose, site-specific) HCP-approved / WFH site-specific adjunctive care recommendation
OpportunityPost-infusion timer / timeline Symptom check-ins (to track improvement or deterioration) Searchable 24/7 curated reference (not a chatbot; no diagnoses) Same-site recovery tracking (historical) Escalation prompts when sx does not improve in 24hr
OpportunitySite-specific activity guidance. Care-team prompt to book physio. Structured post-bleed recovery guidance.
Bottom line
Stages 1 to 3 are the off-hours loop, when no clinician is reachable. Stage 4 is the same patient in office hours.
A HackitRx 2026 entry by AuraHack: Ariel Tan, Rachel Koh, Myo Myo Swe Oo and Gerald Ho. See the team.
