201 - Point-of-Care Ultrasound-Guided Fascia Iliaca Nerve Block Initiative to Improve Care of Children with Femur Fractures in the Pediatric Emergency Department

Poster Number: 201
Publication Number: 201.1735

Background: Point-of-care ultrasound-guided fascia iliaca nerve block (FINB) is a safe and effective method of pain control for children with femur fractures. Descriptions of quality improvement initiatives to safely increase the utilization of this procedure in the pediatric emergency department (PED) are lacking.

Objective: A multidisciplinary team aimed to develop and implement a protocol to safely increase the proportion of eligible patients who receive nerve block for femur fracture in an urban PED.

Design/Methods: After assessments of barriers and key drivers and surveys of provider skill and comfort performing FINB, several Plan-Do-Study-Act (PDSA) cycles were implemented, including: a procedure guide, a nerve block supply box, an educational initiative and online module, a multidisciplinary protocol, and an order panel and note template in the electronic health record (EHR). The EHR was queried for all patients ≥2 years who were treated for femur fracture in the PED from March 2020 to December 2022. The primary outcome was the proportion of eligible patients who received FINB. Due to the relatively rare occurrence of femur fractures, G-chart analysis was utilized. Additional outcomes included PED length of stay, the number of PED attendings supervising or performing the procedure, and the number of complications and ineligible patients receiving a block.

Results: One-hundred and twenty-seven patients ≥2 years of age with femur fractures were identified. Of these, 96 were eligible for nerve block; 24 were ineligible, and 7 with minor fractures (e.g. buckle) were excluded. Twenty-six total patients received blocks, and there were no related complications. G-chart analysis demonstrated a statistically significant decrease in the number of missed opportunities to perform FINB, coinciding with implementation of the nerve block supply box and persisting after the subsequent educational initiative. A higher proportion of eligible patients received FINB after the initiation of these PDSA cycles than before (38.9% vs. 16.7%, p = 0.015). Eligible patients who received FINB had no significant difference in length of stay compared with those who did not (361 mins vs. 379 mins, p = 0.67). The cumulative number of PED attendings who have performed or supervised a fascia iliaca nerve block increased from 2 to 8 over the study period.

Conclusion(s): Ultrasound-guided FINB can be implemented in a pediatric emergency department as an effective and safe form of pain management for femur fracture using simple interventions such as an educational module, procedure guide, supply box, and electronic health record order panel.