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. 2023 Oct 8;7(5):e10912.
doi: 10.1002/aet2.10912. eCollection 2023 Oct.

Implementing ultrasound-guided nerve blocks in the emergency department: A low-cost, low-fidelity training approach

Carrie D Walsh  1 , Irene W Y Ma  2 , Andrew J Eyre  3 , Munaa Dashti  3 , Joseph Stegeman  1 , Roger D Dias  3 , Arun Nagdev  4 , Andrew J Goldsmith  3 , Nicole M Duggan  3
Affiliations

Implementing ultrasound-guided nerve blocks in the emergency department: A low-cost, low-fidelity training approach

Carrie D Walsh et al. AEM Educ Train. .

Abstract

Background: Managing acute pain is a common challenge in the emergency department (ED). Though widely used in perioperative settings, ED-based ultrasound-guided nerve blocks (UGNBs) have been slow to gain traction. Here, we develop a low-cost, low-fidelity, simulation-based training curriculum in UGNBs for emergency physicians to improve procedural competence and confidence.

Methods: In this pre-/postintervention study, ED physicians were enrolled to participate in a 2-h, in-person simulation training session composed of a didactic session followed by rotation through stations using handmade pork-based UGNB models. Learner confidence with performing and supervising UGNBs as well as knowledge and procedural-based competence were assessed pre- and posttraining via electronic survey quizzes. One-way repeated-measures ANOVAs and pairwise comparisons were conducted. The numbers of nerve blocks performed clinically in the department pre- and postintervention were compared.

Results: In total, 36 participants enrolled in training sessions, eight participants completed surveys at all three data collection time points. Of enrolled participants, 56% were trainees, 39% were faculty, 56% were female, and 53% self-identified as White. Knowledge and competency scores increased immediately postintervention (mean ± SD t0 score 66.9 ± 8.9 vs. t1 score 90.4 ± 11.7; p < 0.001), and decreased 3 months postintervention but remained elevated above baseline (t2 scores 77.2 ± 11.5, compared to t0; p = 0.03). Self-reported confidence in performing UGNBs increased posttraining (t0 5.0 ± 2.3 compared to t1 score 7.1 ± 1.5; p = 0.002) but decreased to baseline levels 3 months postintervention (t2 = 6.0 ± 1.9, compared to t0; p = 0.30).

Conclusions: A low-cost, low-fidelity simulation curriculum can improve ED provider procedural-based competence and confidence in performing UGNBs in the short term, with a trend toward sustained improvement in knowledge and confidence. Curriculum adjustments to achieve sustained improvement in confidence performing and supervising UGNBs long term are key to increased ED-based UGNB use.

Keywords: POCUS; models; nerve block; procedure; regional anesthesia; simulation; ultrasound.

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Conflict of interest statement

RDD has received funding from the National Institutes of Health, National Science Foundation, Department of Defense, and the National Aeronautics and Space Agency for investigator‐initiated research. AN is employed by Exo as the senior director for clinical education. AJG has received contract funding from Visby Medical for industry‐initiated research and has also received funding personally from Exo and Philips for consulting. NMD had received contract funding from Visby Medical for industry‐initiated research. The other authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Materials used to make low‐fidelity pork‐based ultrasound‐guided regional anesthesia models.
FIGURE 2
FIGURE 2
Images of targeted nerve block anatomy from a schematic, POCUS images from live patients, images of the pork models, and POCUS images from the pork models for (A) fascia iliaca compartment block, (B) serratus anterior plane block, (C) interscalene brachial plexus nerve block, and (D) transgluteal sciatic nerve block. POCUS, point‐of‐care ultrasound.
FIGURE 3
FIGURE 3
Ultrasound‐guided nerve block competency scores preintervention (t0), immediately postintervention (t1), and 3 months postintervention.
FIGURE 4
FIGURE 4
Self‐reported confidence/comfort with performing ultrasound‐guided nerve blocks preintervention (t0), immediately postintervention (t1), and 3 months postintervention.
See this image and copyright information in PMC

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