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

Carrie D Walsh; Irene W Y Ma; Andrew J Eyre; Munaa Dashti; Joseph Stegeman; Roger D Dias; Arun Nagdev; Andrew J Goldsmith; Nicole M Duggan

doi:10.1002/aet2.10912

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

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

Authors

Carrie D Walsh¹, Irene W Y Ma², Andrew J Eyre³, Munaa Dashti³, Joseph Stegeman¹, Roger D Dias³, Arun Nagdev⁴, Andrew J Goldsmith³, Nicole M Duggan³

Affiliations

¹ Harvard Affiliated Emergency Medicine Residency Program, Department of Emergency Medicine Mass General Brigham Boston Massachusetts USA.
² Division of General Internal Medicine, Cumming School of Medicine University of Calgary Alberta Canada.
³ Department of Emergency Medicine, Brigham and Women's Hospital Harvard Medical School Boston Massachusetts USA.
⁴ Department of Emergency Medicine Highland Hospital, Alameda Health System Oakland California USA.

PMID: 37817836
PMCID: PMC10560751 (available on 2024-10-08)
DOI: 10.1002/aet2.10912

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.