Emergency Department Fascia Iliaca Block Catheters: A Safe and Feasible Pathway to Hip Fracture Analgesia

PROBLEM: Nerve blocks confer major benefits for patients with hip fractures, but the average time to surgery exceeds the duration of a single injection. We addressed this with an initiative to credential emergency department (ED) doctors and rural generalists to place fascia iliaca block catheters (FIBC), enabling ongoing analgesia until the time of surgery. SETTING: Cairns and Hinterland Hospital and Health Service, the major referral hospital for Far North Queensland. KEY MEASURES FOR IMPROVEMENT: Proportion of hip fracture patients receiving an FIBC in ED or prior to interhospital transfer, time from arrival to block insertion, and complication rates. STRATEGIES FOR CHANGE: Multidisciplinary initiative involving a formal training program and protocol for FIBC insertion, with ongoing follow-up by the acute pain service. EFFECTS OF CHANGE: ED doctors now place the majority of FIBC for our hospital, with a median time to block of 4.5 h compared to 13.2 h by anaesthetists (p < 0.001). Over 40% of patients from rural centres receive an FIBC before transfer. Complication rates were low and similar across specialties. LESSONS LEARNT: FIBC insertion in ED and rural hospitals was feasible and safe after a simple training program. Multidisciplinary collaboration was essential to the success of the program.