Regional Anesthesia as an Emergency Department Consulting Service: A Quality Improvement Pilot Study

Despite evidence that regional anesthesia may facilitate earlier discharge and lower outpatient opioid utilization, a multitude of systemic and cultural barriers reduce the utilization of regional anesthesia in the emergency setting. An accessible regional anesthesia team was created to assess Emergency Department (ED) utilization of nerve blocks and their impact on patient pain improvement.

ED providers in a non-trauma hospital had a regional anesthesia team available as a consulting service for five months. Patients were enrolled based on inclusion criteria and at the discretion of the ED attending. Enrolled patients underwent peripheral nerve blocks with one of two anesthesiologists who were fellowship trained in Regional Anesthesiology. Patients were then contacted on post-procedure day 1 and were interviewed regarding their satisfaction with the process and their ultimate post-ED disposition.

Participation was limited due to multiple systemic and cultural factors. The majority of patients enrolled participated in the follow-up survey and rated their pain relief as 'Very Good' or 'Excellent' (n=9/14). Nearly all patients (n = 11/14) responded 'Strongly Agree' to whether they would use the same type of pain relief method in the future, and most (n=11/14) rated their overall experience with their pain management service as 'Excellent' or 'Very Good'.

This pilot study showed that implementation of a regional anesthesia consulting service in the ED was feasible and that the majority of patients were satisfied with the quality of care and the timeframe in which they were provided regional anesthesia for acute pain.