ED Ultrasonographic Regional Anesthesia to prevent Incident Delirium in Hip Fracture Patients (EDU-RAPID)

Principal Investigator: Jacques Lee, Sunnybrook Research Institute

Local Investigator: Marcel Émond, MD, MSc, Centre de recherche du CHU de Québec- Université Laval

Co-investigators : Bhandari, T; Borgundvaag, B; Chenkin, J; Chopra, A; Daoust, R; Friedman, S; Haslam, L; Idestrup, C; Jenkinson, R; Kiss, A; Kreder, HJ; Melady, D; Newbigging, J; Ovens, H;

Local research professional: Claire d’Assise Nduwamariya

Granting agency: Canadian Institutes of Health Research – CIHR

Hip fractures are a «burden» for the health care system. It is estimated that milliards of dollars per year are spent for this condition in this country alone. In the future this «burden» is expected to grow since we are faced with increasing aging of the population. The total absolute number is expected to rise up to 45% in the coming years even with a relatively decreasing incidence among the population. Delirium is the most dreaded complication when a hip fracture occurs. This complication of confusion brings on a multitude of problems for the patient and its family: an impairment of autonomy, delay in hospitalization and sometimes death. Regional anesthesia, with nerve bloc in broken hip with an injection, would prove to relieve pain and at the same time, reduce the occurrence of delirium. Unfortunately, ultrasonographic regional anesthesia is under used by the emergency physicians despite the evidence-based efficacy of this technical approach. This technical intervention is proven to be safe for the patient. It is necessary to develop a strategy of implementation to improve the utilization of this technique.

Main objective: The main objective of this study is to measure the proportion of new case of delirium at 7 days post injury and visit to ED in terms of nerve bloc intervention or not

Method: A randomized cluster study and wedge study where the ED physician is randomized to receive a formation KTP (Knowledge To Practice Intervention) strategy will be used. Doctors will be randomized by small groups and will receive the formation over a period of approximately 18-20 months. This way, the first physicians to receive the formation will be encourage to use the nerve bloc on the eligible patients during their shifts. The nerve bloc will be used 2 hours following the confirmation of hip fracture by radiology pictures. The other doctors will be the control group as well as their patients who are victims of hip fracture during this period. Following, 8-9 weeks, another small group of physician will be ns will be selected and will apply the nerve bloc treatment. This process will be repeated until all the doctors have the formation of KTP. All the patients presenting a hip fracture will have surgery and will be followed by the research team whether or not they have had regional anesthesia. The follow up will be done up to 7 days after the insult or the visit to the ED. This will ensure to get the outcomes of the study. The physician who will perform the nerve bloc will demand a verbal consent from the patient to meet the research team. The patient who will not get the intervention (nerve-bloc) will be the control group and they will be asked by the treatment team to get a verbal consent. A written consent will be completed by a research team member to administer the surveys, following their verbal consent

Hypothesis: It is to suggest that a strategy (Knowledge to Practice Intervention-KTP) transfer of knowledge and practices could facilitate and encourage the ED physicians to use the nerve bloc anesthesia through ultrasonography and influence the future of the patient.

Expected Results: Early use of nerve bloc, in emergency department, could reduce the complications due to delirium after a hip fracture.