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. 2025 Aug 18.
doi: 10.1007/s43678-025-00990-7. Online ahead of print.

Improving the rate of use of fascia iliaca compartment blocks in patients presenting with hip fractures

Kristin O'Neill  1 , Joseph Boyle  1 , Logan Haynes  1 , Brittany Ellis  1 , Rob Woods  1 , Taofiq Oyedokun  1 , Sachin V Trivedi  2
Affiliations

Improving the rate of use of fascia iliaca compartment blocks in patients presenting with hip fractures

Kristin O'Neill et al. CJEM. .

Abstract
in English, French

Background: Patients presenting to the emergency department (ED) with hip fractures are typically treated with opioids, which are associated with adverse events such as delirium and respiratory depression. The fascia iliaca compartment block (hereafter fascia iliaca block) is a regional analgesia technique which avoids these negative outcomes. We sought to increase the rate of use of this technique to 50% of all patients with hip fractures who presented to our EDs within an 18-month period.

Methods: We held three Plan-Do-Study-Act cycles designed in accordance with surveys sent to our physician group. The first cycle consisted of the dissemination of educational materials and standardization of equipment carts. Next, we held educational sessions for staff and trainee physicians. The third cycle consisted of additional education, Audit and Feedback methodology and incentives. Our outcome measure was the rate of fascia iliaca blocks performed. We tracked the number of unique physicians performing the fascia iliaca block as well as physician-reported comfort with the procedure for our process measures. Our balancing measure was the rate of adverse events.

Results: We went from a baseline rate of 2.0% to 22.6% of patients receiving fascia iliaca blocks. The number of physicians doing this increased from 6 pre-project to 35. Only one adverse event occurred (arterial puncture), which did not cause any significant patient harm. Our statistical process control chart revealed special cause variation in the form of a shift.

Conclusion: Although we did not meet our goal, we were able to significantly improve the rate of fascia iliaca blocks performed at our center. This was largely achieved through educational interventions. Our approach can be adapted by other centers looking to pursue a similar project.

RéSUMé: OBJECTIFS: Les patients qui se présentent au service des urgences avec une fracture de la hanche sont généralement traités avec des opioïdes, qui sont associés à des événements indésirables comme le délire et la dépression respiratoire. Le bloc du compartiment fascia iliaca (ci-après bloc fascia iliaca) est une technique d’analgésie régionale qui évite ces résultats négatifs. Nous avons cherché à augmenter le taux d’utilisation de cette technique pour atteindre 50 % de tous les patients ayant des fractures de la hanche qui se sont présentés à nos SU dans une période de 18 mois. MéTHODES: Nous avons tenu trois cycles Planifier-Faire-Étudier-Agir conçus conformément aux sondages envoyés à notre groupe de médecins. Le premier cycle a consisté en la diffusion de matériel pédagogique et la standardisation des chariots d’équipement. Ensuite, nous avons tenu des séances éducatives pour le personnel et les médecins stagiaires. Le troisième cycle a consisté en une formation supplémentaire, une méthodologie d’audit et de retour d’information et des incitations. Notre mesure de résultat était le taux de blocs de fascia iliaca effectués. Nous avons suivi le nombre de médecins uniques réalisant le bloc de fascia iliaca ainsi que le confort rapporté par le médecin avec la procédure pour nos mesures de processus. Notre mesure d’équilibrage était le taux d’événements indésirables. RéSULTATS: Nous sommes passés d’un taux de base de 2,0 % à 22,6 % des patients recevant des blocs de fascia iliaca. Le nombre de médecins qui font cela est passé de 6 avant le projet à 35. Un seul événement indésirable s’est produit (ponction artérielle), qui n’a pas causé de préjudice important au patient. Notre graphique de contrôle statistique des processus a révélé une variation par cause spéciale sous la forme d’un décalage. CONCLUSION: Bien que nous n’ayons pas atteint notre objectif, nous avons pu améliorer considérablement le taux de blocs de fascia iliaca réalisés dans notre centre. Cela a été en grande partie réalisé grâce à des interventions éducatives. Notre approche peut être adaptée par d’autres centres cherchant à poursuivre un projet similaire.

Keywords: Hip fractures; Quality improvement; Regional analgesia.

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Conflict of interest statement

Declarations. Conflict of Interest: Dr. Sachin Trivedi has previously received an honoraria from Boehringer Ingelheim for moderating an unrelated symposia. He has also been a recipient of the 2024 CAEP QIPS grant. Dr. Brittany Ellis has received honoraria from Elsevier for editorial services rendered. She has also received grants from CAEP (2024 QIPS grant), CIHR and the University of Saskatchewan. This project in particular was funded through the 2021 CAEP QIPS grant. None of these listed conflicts were relevant to the performance of this project.

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