One-Year Prospective Audit of Truncal Blocks Using Regional Anesthesia Database App

Abstract

Aims and Objectives: Truncal blocks like chest and abdominal wall peripheral nerve blocks have been reported to be an effective method of providing analgesia for surgeries on the chest wall and the abdomen. We present results of a prospective audit of the practice and outcomes of these techniques using a novel mobile app and web-based e-audit tool (RAD app and national database ®) to identify safety and quality with description of newer blocks. Design: Prospective single centre audit over a 1-year period using e-clinical audit tool (RAD app and national database®) Setting: 210 bedded NABH accredited multi-speciality Private hospital. Patients: All patients who had Peripheral nerve blocks for chest and abdominal surgeries Measurements: Data on practice, clinical and patient related outcome measures were prospectively entered in the mobile app and web-entries. Data analysis is automated and summary statistics with comparison to national data is presented here. Results: Data analysis is automated and summary statistics with comparison to national data is presented. 147 patients received 199 blocks between 3rd July 2017 to 2nd July 2018.Youngest patient was 1 year old and oldest being 84 years of age. 40% of patients were males and 15.4% of surgeries were for emergency reasons. Few new blocks were added into our practice during this year including the erector spinae plane block, quadratus lumborum block and serratus plane block. The overall quality and safety of these new blocks are comparable to Indian national benchmark and available literature.A number of differences in practice compared to national sample data is identified including greater use of ultrasound in our practice(70% vs 31.6% nationally), significantly, more blocks are done pre-operatively (75% compared to 50% nationally). Outcomes in terms of success rates and post-operative analgesia, opioid consumption are comparable.40% of our patients had opioid free surgery and 85% of the patients had no analgesic requirement in their recovery period.Quality assurance audit data shows that only 63.3% of the patients had correct site check/block specific time-out done. Ultrasound probe cover was not used in 95% of the cases. Patient related outcome measures are reported for the first time showing high rates of satisfaction and likelihood of having regional anaesthesia/analgesia again. Conclusions: This is the first reported audit of peripheral nerve blocks of chest and abdomen in India. This audit was enabled by an e-audit tool (RAD app and database®) which removed many barriers in doing clinical audit in busy day-to-day practice. The audit was done with minimal effort using smart entry system and automated analysis of graphs and charts. The project is ongoing and data from 1st year is reported to identify practice and outcomes of our regional anaesthesia practice. A number of practice changing recommendations are identified to further improve quality and safety of our regional anaesthesia practice. Recommendations: 1. Correct site check and timeout before block to be 100%. STOP before block to be ensured in 100% of patients. 2. Ultrasound Probe cover to ensure sterility is maintained should be achieved in 100%. 3. Ensure more than 90% complete data collection to measure the Patient related outcome measures as accurately as possible. Keywords: Peripheral nerve blocks, Audit, Regional Anaesthesia, Truncal blocks, chest and abdominal wall blocks, Database