LO055: Increased utilization of Bier block for pediatric forearm fracture reduction following simulation and web-based training

Abstract

Introduction: Bier block (BB) regional intravenous anesthesia is a safe and effective alternative to procedural sedation for analgesia during forearm fracture reductions, yet BB remains infrequently utilized in the Pediatric Emergency Department (PED). No standardized methods of BB training have previously been described. The objectives of this study were to evaluate comfort and level of experience with BB in the PED, and to determine if a multimodal instructional course increases these from baseline and translates to increased utilization of this technique. Methods: A novel interdisciplinary simulation and web-based training course was developed to teach the use of BB for forearm fracture reduction at a tertiary PED. Participants were surveyed pre/post training, and at 2- and 6-months regarding their comfort with and willingness to use BB. In parallel, we prospectively assessed the clinical utilization of BB in the PED during the 24-month period immediately following course completion. Results: Course participation included 38 members of the PED (N = 26 physicians, 12 nurses), and survey response rate was 100% at all time points. Respondents reported that course participation increased both their comfort (10% pre vs. 89% post-training, p<0.001) and willingness (51% pre vs. 95% post-training, p<0.001) to use BB for forearm fracture reduction, an effect that was sustained at 6-months following course completion (66% and 92%, respectively, p<0.001 for both). Before course attendance, only 6% of respondents indicated that they had ever used BB in a PED setting, and all participants indicated that the course addressed their learning objectives. In clinical practice, there were no BB performed prior to course administration. We observed a consistent and sustained increase in the clinical utilization of BB, with 39% of all PED forearm reductions performed using BB at 24-months post-course completion (114 BB, 17 unique physicians). Conclusion: A combined simulation and web-based training course increased comfort and willingness to use BB and was associated with increased utilization of this technique for forearm fracture reduction in the PED.