Implementation of an Ultrasound-Guided Regional Anesthesia Program in the Emergency Department of a Community Teaching Hospital

Robert A Farrow 2nd; Michael Shalaby; Mark A Newberry; Roman Montes De Oca; David Kinas; David A Farcy; Tony Zitek

doi:10.1016/j.annemergmed.2023.11.013

Implementation of an Ultrasound-Guided Regional Anesthesia Program in the Emergency Department of a Community Teaching Hospital

Ann Emerg Med. 2023 Dec 22:S0196-0644(23)01382-3. doi: 10.1016/j.annemergmed.2023.11.013. Online ahead of print.

Authors

Robert A Farrow 2nd¹, Michael Shalaby², Mark A Newberry², Roman Montes De Oca³, David Kinas², David A Farcy², Tony Zitek²

Affiliations

¹ Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL; Department of Emergency Medicine and Critical Care, Herbert Wertheim College of Medicine at Florida International University, Miami, FL. Electronic address: Robert.FarrowII@msmc.com.
² Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL; Department of Emergency Medicine and Critical Care, Herbert Wertheim College of Medicine at Florida International University, Miami, FL.
³ Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL.

PMID: 38142373
DOI: 10.1016/j.annemergmed.2023.11.013

Abstract

Study objective: We sought to initiate an emergency department (ED)-based ultrasound-guided regional anesthesia (UGRA) program in our community teaching hospital system. Here, we present our development process and protocol. We also sought to assess the types, indications, and associated adverse event rates for the UGRA procedures in this study.

Methods: We conducted a retrospective analysis of prospectively collected quality assurance data from a case series of patients who underwent an UGRA procedure in the ED. In August 2020, we developed an UGRA program for our community teaching hospital and its 2 affiliated freestanding EDs. For quality assurance purposes, we tracked all UGRA procedures performed in the ED, and we specifically assessed adverse events using structured follow-up. We subsequently obtained approval from our institutional review board to perform chart reviews of the patients in our dataset to abstract additional data and formally perform a research study. We determined the frequency with which different UGRA procedures were performed, and we calculated the adverse event rate.

Results: Between August 24, 2020, and July 15, 2022, a total of 18 different sonographers performed and documented 229 UGRA procedures on 206 unique patients. This included 28 different types of procedures. Follow-up after disposition was successful in 82.0% of patients. In 2 cases, the patient reported no pain relief at all from the procedure, but no patients reported complications related to the procedure.

Conclusion: We successfully initiated a robust ED-based UGRA program in our community teaching hospital system. Among patients with successful follow-up, no adverse events were identified.