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

Abstract

AbstractBackgroundManaging 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.MethodsIn 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.ResultsIn 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).ConclusionsA 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.