2024 FSA Podium and Poster Abstracts
P021: IMPACT OF A PERIOPERATIVE BLOCK NURSE AT A COMMUNITY-BASED LEVEL 1 TRAUMA CENTER
Tilman Chambers, MD1; Jessica Bonilla, MD1; Stephan Mouhanna, MD1; Kavan Clifford, MD, PhD2; Kiesha Raphael, MD2; Gary Gomez, MD, MBA2; Benjamin T Houseman, MD, PhD2; 1Memorial Hospital System; 2Envision Physician Services
Introduction: The use of regional nerve blocks is a foundational pillar of enhanced recovery programs (1), but the development of a robust regional anesthesia program requires significant investment in materials, clinician time and workflows (2). Dedicated “block” nurses that assist clinicians with regional anesthesia procedures has benefited the growth and operational efficiency of regional anesthesia programs in large academic practices (3), but the impact of a block nurse in a busy community-based anesthesia practice is less clear. This abstract describes the impact of a block nurse in our 800+ bed trauma and regional referral center.
Materials and Methods: We analyzed billing records for anesthesia cases at the medical center between 2022 and 2024 (n=41557) and identified records that billed for regional anesthesia. To account for changes in case mix and case volumes that occurred throughout the year, we calculated the percent of cases receiving a regional anesthetic and compiled data in three-month periods (quarters 1-4). A student t-test was performed to determine whether the percent of cases receiving a block in different quarters was statistically significant.
To assess the impact of the block nurse on our physician practice, faculty were asked to complete a brief four question survey using a 5-point Likert scale (1= strongly disagree, 5 = strongly agree).
Results: Figure 1A shows that our team typically performed between 5300 and 5700 cases each quarter, with block percentages ranging from 5.9% to 11.9%. These cases include elective and urgent/emergent cases in the main operating rooms as well as non-OR locations. The addition of a block nurse to our practice did not result in a significant increase in the proportion of total cases receiving regional anesthesia (6.5% to 8%; P=0.1).
A survey of 13 attending anesthesiologists at our hospital showed that the presence of a block nurse increased job satisfaction by freeing up significant time for other physician duties, increased the number of blocks performed, and increased the consistency and quality of blocks in their practice through standardization. The survey also demonstrated standardized block syringes as a potential to improve block utilization in a high-volume practice.
Discussion: The perioperative block nurse improved clinician care experience but failed to result in a statistically significant increase in regional anesthesia at our high-volume referral center. To assess factors that may have contributed to this result, a root cause analysis was performed (Figure 1B). Potential contributing factors include clinician and patient resistance to blocks as well as system issues that impeded block placement. We are in the process of implementing an intervention bundle to address these barriers. These interventions include prefilled block syringes; additional education of surgical, nursing and anesthesia teams; proactive engagement of surgeons and patients regarding opportunities for regional anesthesia; and the use of visual aids to track block performance in real time (4).
References:
doi: 10.1001/archsurg.2009.170
2) doi: 10.1002/aorn.13316
3) doi: 10.1016/j.jopan.2012.06.007
4) doi: 10.1136/bmjoq-2018-000346
