Abstract
OBJECTIVES:
Determine adherence to a newly implemented protocol of fascia iliaca compartment block (FICB) in geriatric hip fractures.
METHODS:
Design:
Retrospective review.
Setting:
Level I trauma center.
Patient S election C riteria:
Patients with a hip fracture treated with cephalomedullary nailing or hemiarthroplasty (CPT codes 27245 or 27236).
Outcome M easures and C omparisons:
Adherence to a protocol for FICB, time intervals between emergency department arrival, FICB, and surgery stratified by time of admission.
RESULTS:
Three hundred eighty patients were studied (average age 78 years, 70% female). Approximately 53.2% of patients received an FICB, which was less than a predefined acceptable adherence rate of 75% (P < 0.001). Approximately 5.0% received an FICB within 4 hours and 17.3% within 6 hours from admission. Admission during daylight hours (7am–7pm) when compared with evening hours (7pm–7am) was associated with improved timeliness ([8.3% vs. 0% within 4 hours, P < 0.001] [27.5% vs. 2.4% within 6 hours, P < 0.001]). Improved adherence to the protocol was observed over time (odds ratio: 1.0013, 95% confidence interval, 1.0001–1.0025, P = 0.0388).
CONCLUSIONS:
FICB implementation was poor but gradually improved over time. Few patients received an FICB promptly, especially during night hours. Overall, this study demonstrates that implementation of an FICB program at a Level I academic trauma center can be difficult; however, many hurdles can be overcome with institutional support and dedication of resources such as staff, space, and additional training.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Orthopedics and Sports Medicine,General Medicine,Surgery