Gu Yuqi, McIsaac Daniel I, Hladkowicz Emily, Barnes Keely, Boet Sylvain, McCartney Colin, Ramlogan Reva
Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Can J Anaesth. 2025 Mar;72(3):460-472. doi: 10.1007/s12630-025-02912-8. Epub 2025 Feb 14.
Peripheral nerve blocks (PNBs) in older adult patients with a hip fracture improve morbidity and mortality, reduce health care costs, and improve quality of care. Despite the benefits, PNB use rates remain low. We aimed to use the Theoretical Domains Framework to investigate the barriers and facilitators to PNB use in patients with a hip fracture from the perspective of Canadian anesthesiologists.
We created an online survey that collected both quantitative and qualitative responses. After research ethics board approval, the survey was distributed among all Canadian Anesthesiologists' Society (CAS) members. We present five-point Likert responses as medians and interquartile ranges [IQRs], conducted thematic analysis on the narrative feedback, and performed cluster analysis to explore patterns associated with survey responses.
We obtained responses from 256/2,498 (10.2%) CAS members. Of these respondents, 215 (84%) performed PNBs for patients with a hip fracture. The median [IQR] five-point Likert responses showed that participants felt confident placing a PNB (4 [4-5]) and agreed they possessed adequate knowledge and skills for PNB placement (4 [4-5]). Participants' responses showed lower ratings with greater variability for availability of adequate time (3 [3-4]), collaboration with the perioperative team (4 [2-4]), and adequate resources (4 [3-5]). Barriers to PNB use identified through thematic analysis included time pressure as well as inadequate human resources, training opportunities, and multidisciplinary collaboration with other health care professionals. Facilitators included more education, dedicated resources, and clinical care pathways.
Our results identified several barriers and facilitators related to physical resources, operational support, and educational factors that may inform future interventions to increase PNB use in older patients with a hip fracture. The results of this study may not be generalizable to all Canadian practice settings because of a low response rate and high proportion of respondents who performed PNBs at their local institution.
对老年髋部骨折患者实施外周神经阻滞（PNB）可改善发病率和死亡率，降低医疗成本，并提高护理质量。尽管有这些益处，但PNB的使用率仍然很低。我们旨在运用理论领域框架，从加拿大麻醉医生的角度调查髋部骨折患者使用PNB的障碍和促进因素。
我们创建了一个在线调查问卷，收集定量和定性的回答。经研究伦理委员会批准后，该调查问卷在所有加拿大麻醉医生协会（CAS）成员中分发。我们将五点李克特量表的回答以中位数和四分位间距[IQR]呈现，对叙述性反馈进行主题分析，并进行聚类分析以探索与调查回答相关的模式。
我们从2498名CAS成员中的256名（10.2%）获得了回复。在这些受访者中，215名（84%）为髋部骨折患者实施PNB。五点李克特量表回答的中位数[IQR]显示，参与者对实施PNB感到有信心（4[4 - 5]），并同意他们具备实施PNB的足够知识和技能（4[4 - 5]）。参与者的回答在充足时间的可获得性（3[3 - 4]）、与围手术期团队的协作（4[2 - 4]）和充足资源（4[3 - 5]）方面得分较低且变异性较大。通过主题分析确定的PNB使用障碍包括时间压力以及人力资源不足、培训机会不足和与其他医疗保健专业人员的多学科协作不足。促进因素包括更多教育、专用资源和临床护理路径。
我们的结果确定了与物质资源、操作支持和教育因素相关的几个障碍和促进因素，这可能为未来增加老年髋部骨折患者PNB使用的干预措施提供参考。由于回复率低以及在当地机构实施PNB的受访者比例高，本研究结果可能不适用于所有加拿大的实践环境。
