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MP34: Block that Hip! Improving rates of ultrasound-guided fascia iliaca compartment blocks for hip fracture analgesia in the emergency department: a quality improvement initiative

Published online by Cambridge University Press:  13 May 2020

M. Crickmer
Affiliation:
University of Toronto, Toronto, ON
A. Cameron
Affiliation:
University of Toronto, Toronto, ON
D. Smith
Affiliation:
University of Toronto, Toronto, ON
S. Ward
Affiliation:
University of Toronto, Toronto, ON
A. Wong
Affiliation:
University of Toronto, Toronto, ON
K. Wong
Affiliation:
University of Toronto, Toronto, ON
A. Cheng
Affiliation:
University of Toronto, Toronto, ON
J. Chu
Affiliation:
University of Toronto, Toronto, ON
J. Lockwood
Affiliation:
University of Toronto, Toronto, ON
A. Petrosoniak
Affiliation:
University of Toronto, Toronto, ON
S. Vaillancourt
Affiliation:
University of Toronto, Toronto, ON

Abstract

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Background: In patients with acute hip fracture, a fascia iliaca compartment block (FICB) has been shown to provide effective non-opioid analgesia, reduce the incidence of pneumonia, and potentially decrease the rate of delirium [1]. However, this procedure was infrequently used in the St. Michael's Hospital (SMH) emergency department (ED). Aim Statement: Our aim was to increase the proportion of patients with hip fracture receiving FICB in the ED to 50% in six months. Measures & Design: We completed two Plan-Do-Study-Act (PDSA) cycles, measuring rates of FICB before and after each cycle. The first was a departmental rounds presentation with information about the process and benefits of FICB, addressing barriers identified by surveying the group. The second cycle included a bundle of interventions comprising of an “instruction card” with the steps required to do the procedure, access to a video tutorial, and a list of experienced physicians willing to help less experienced providers perform FICB. Evaluation/Results: In the three months prior to the project, the rate of FICB in the ED was 12.5% (3/24). For the three months after the first PDSA cycle, the rate increased to 22.2% (8/36). Then, the second cycle was performed. In the following two months the rate further increased to 36.8% (7/19). Discussion/Impact: Despite the clear increase in FICB rate, these changes were not statistically significant (p = 0.063). Our methodology was shown to be safe and effective, and our model can be applied to other ED groups looking to increase their rates of FICB.

Type
Moderated Poster Presentations
Copyright
Copyright © Canadian Association of Emergency Physicians 2020
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