Aims: The primary aim is to investigate the utilisation of regional nerve blocks at a major metropolitan hospital Emergency Department before and after the implementation of the Emergency Department Fractured Neck of Femur (NOF) Pathway. The secondary aims include assessing differences in mobility and pain scores between pre- and post-intervention groups. Other secondary aims include assessing for a difference in the administration of regional nerve blocks between those who had cognitive impairment and/or delirium, compared to those without.
Methods: The Fractured NOF Pathway was commenced on 1st July 2019 in the Emergency Department. Patient data was obtained from 1st January 2017 to 31st December 2021.
Results: There were 186 patients in the pre-intervention group and 182 patients in the post-intervention group. 147 participants in the pre-intervention group had a nerve block performed, compared to 153 in the post-intervention group (P value 0.214). Notably, there were significantly increased femoral nerve blocks in the pre-intervention group and significantly increased fascia iliac blocks in the post-intervention group (P value <0.0001). No significant differences were noted between intervention groups with regards to secondary end-points.
Conclusions: The rates of nerve block administration was high at 79% in the pre-intervention group and this saw a further small, but not statistically significant increase (to 84%) following the roll out of the Fractured NOF Pathway. Ongoing work is still required to increase the rate of nerve block administration further for patients with neck of femur fractures.