Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Ultrasound-guided nerve blocks (UGNB) are an effective and safe method of pain control that are increasingly used for pain management in the emergency department (ED). However, performing these procedures is often time-intensive due to the need to locate and gather necessary supplies. Our ED recently implemented use of a nerve block cart, which contains all the supplies needed for performing a nerve block. Our objective in this quality improvement study was to assess whether the presence of an ED nerve block supply cart was associated with an increase in the number of UGNBs performed.

Methods: We conducted a retrospective review of point-of-care ultrasound examinations performed in a single academic quaternary-care community ED over 22 months, looking at 11-month time periods before and after implementation of an ED nerve block supply cart in March 2023. Our primary outcome measure was documentation of a UGNB, and our secondary outcome measure was the type of UGNB performed.

Results: We reviewed 14,321 ultrasound exams over 22 months—11 months pre-cart (6,853) and 11 months post-cart (7,468) implementation. We noted a statistically significant increase in the number of UGNBs, from 21 performed in the pre-cart period (0.31% of all ultrasound exams [95% CI, 0.17- 0.43%], to 50 UGNBs in the post-cart period (0.67% of all ultrasound exams [95% CI, 0.46- 0.86%], P < .01). The fascia iliaca block was the most common UGNB performed in both the pre- (52.4%) and post-cart (62.0%) periods.

Conclusion: We found that the deployment of an ED nerve block supply cart was associated with an increased number of ultrasound-guided nerve blocks performed by emergency clinicians in our hospital.