# New Kids on the Block: Development and Assessment of a Multispecialty Fascia Iliaca Block Protocol and Training Program for Geriatric Hip Fracture in the Emergency Department

## TL;DR

A new training program for a nerve block technique improved pain management for elderly hip fracture patients in the emergency department.

## Contribution

A multispecialty training program for ultrasound-guided fascia iliaca blocks in geriatric hip fracture care was developed and implemented.

## Key findings

- Before training, only 4% of emergency medicine providers knew how to perform the block, but after training, 100% did.
- The program led to 37 blocks performed in the ED over 15 months, representing 15% of hip fracture cases.
- Emergency medicine providers previously did not perform the block, but the protocol led to sustained adoption.

## Abstract

Background

Hip fracture is a common presentation to emergency departments. Opioid-based medications are often used for analgesia but are associated with increased morbidity and mortality. Regional anesthesia for hip fractures can improve pain and other outcomes with minimal risk. The adoption of this procedure in the emergency department and perioperative space is low due to a lack of training and inadequate buy-in from consultants.

Methods

The Departments of Emergency Medicine, Anesthesiology, Orthopedic Surgery, Pharmacy, and Nursing collaborated to develop a multispecialty ultrasound-guided infrainguinal fascia iliaca block (FIB) protocol and training program at a large, urban, Level 1 trauma center. Training for emergency medicine physicians consisted of a one-half-hour lecture teaching the FIB technique, recognition and treatment of local anesthetic systemic toxicity (LAST), where to find the necessary equipment, and how to utilize the FIB order set and procedure note template in the electronic medical record. Learners then participated in a one-half-hour simulation session using a high-fidelity, inexpensive, do-it-yourself model. To assess the participants’ perceived knowledge and comfort with the FIB, we administered a survey to participants immediately before and after the training sessions.

Results

Prior to training, 4% (n = 48) of emergency medicine (EM) participants reported that they knew how to perform the block, and 2% felt comfortable doing so. After training, 100% of the participants reported knowing how to perform the block, and 92% felt confident performing the procedure. From March 2022 to June 2023, 37 FI blocks were performed in the emergency department (ED), representing 15% of the 249 hip fractures presenting to the ED during this time. Prior to the intervention, EM providers were not performing the block.

Conclusion

The utilization of nerve blocks in our geriatric hip fracture population increased dramatically and persistently with the institution of this protocol.