Ensuring Patient Safety in Emergency Peripheral Ultrasound-Guided Nerve Blocks: An Evaluation of a Quality Improvement/Patient Safety Initiative

Daniel J Wahl,Nikolai Butki,Andrew J Butki,Samuel J Wisniewski

doi:10.51894/001c.7402

Daniel J Wahl, Nikolai Butki + Show 2 more

Open Access

https://doi.org/10.51894/001c.7402

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Abstract

CONTEXTDuring the past two decades, bedside ultrasound has revolutionized the practice of emergency medicine. Physicians are now expected to be competent in utilizing ultrasound skills, for patients presenting with conditions ranging from trauma to skin evaluations. The overall purpose of this quality improvement/patient safety (QIPS) project was to evaluate the effectiveness of a pair of five-hour, hands-on didactic/training sessions, aimed at preparing a sample of emergency medicine physicians, residents and medical students to perform peripheral ultrasound-guided nerve blocks.METHODSThe study location was set in a community-based emergency medicine program in Pontiac, Michigan. Data was collected from N = 54 emergency medicine residents, physicians and medical students. Data was collected from two training sessions in November 2017 and January 2018. The training consisted of a 12-question pre-test, followed by five hours of hands on & didactic training, with a subsequent post-test containing the same questions.RESULTSThe authors compiled the data from both training sessions and found that the participants had an average correct percentage of 5.52 of 12 (46%) on the pre-test. After attending the training session, participants had an overall correct percentage of 9.24 of 12 (77%) on the post-test. This pre-to post-training increase of the mean scores was statistically significant, t (53) = -10.76 (p < 0.01), with an effect size (Cohen’s d) of 1.82. Post hoc power calculations utilizing the d = 1.82 effect size revealed statistical power (1- β) of 100%.CONCLUSIONSThe results of this QIPS evaluation project suggest that emergency physicians, residents and medical students may achieve an improved understanding of key ultrasound-guided nerve block material after a single five-hour session of hands-on training and didactics. Going forward, additional studies employing larger sample sizes that allow for outcome stratification by group (emergency physicians, residents, or medical students) along with relevant demographic variables (age, years in practice, etc.) in similar settings are needed to further verify these findings.

Highlights

During the past two decades, bedside ultrasound has revolutionized the practice of emergency medicine (EM)
The generation of emergency physicians are expected to be competent in utilizing ultrasound (US) skills for patients presenting with conditions ranging from trauma to skin evaluations.[1]
In 1989, Ting and Sivagnanaratnam described using ultrasonography to localize a needle while performing an axillary nerve block.[4]

Summary

Introduction

During the past two decades, bedside ultrasound has revolutionized the practice of emergency medicine (EM). The generation of emergency physicians are expected to be competent in utilizing ultrasound (US) skills for patients presenting with conditions ranging from trauma to skin evaluations.[1] A rapidly evolving use of bedside ultrasound in EM is combining fine motor skills with knowledge of peripheral nervous system anatomy and physiology to perform US-guided nerve blocks.[2]. The history of US-guided regional anesthesia has quickly evolved over the last 25 years.[3] In 1989, Ting and Sivagnanaratnam described using ultrasonography to localize a needle while performing an axillary nerve block.[4] They reported no patient complications, due to visualizing the needle and surrounding anatomy at all times.[4] In 1994, Kapral et al demonstrated the benefits of US for supraclavicular

Results

Discussion

Conclusion