Schwartz/Reisman Emergency Medicine Institute


The ED Ultrasonographic Regional Anesthesia to Prevent Incident Delirium (EDU-RAPID) Study

Hip fractures affect over 30,000 Canadians each year. Delirium, or acute confusion, occurs in up to 62% of patients following a hip fracture. Delirium doubles the risk of death and nursing home admissions, adds 8 days to the average hospital length of stay, and increases the burden on nursing staff. Ultrasound Guided Regional Anesthesia (USGRA) or nerve "freezing" is the optimal pain management strategy for hip fracture patients, and has been shown to independently reduce the rate, severity and duration of delirium. However, very few emergency physicians have the necessary training and experience to use USGRA for hip fracture in the emergency department (ED).

SREMI researchers have partnered with Dr. Jacques Lee from Sunnybrook Health Sciences Centre on a CIHR-funded, multi-center, cluster, randomized clinical trial to test whether a knowledge to practice (KTP) intervention to train, facilitate and encourage ED physicians to use USGRA can reduce new cases of delirium following hip fractures. We will measure the proportion of patients with incident delirium in the first 7 post-operative days among patients treated by ED physicians randomized to the KTP intervention group compared to patients treated by control group ED physicians.

This trial will be the largest randomized clinical trial to date, will be the first to use ultrasound guidance, and will be the first to initiate regional anesthesia at the earliest opportunity for all patients (i.e., in the ED). We believe this trial will help change practice and improve the care of older Canadians.