Hip fractures are common, costly and affect older people - Canadians spend 1 billion dollars
to treat hip fractures each year. Unfortunately, as many as two-thirds of hip fracture cases
suffer a complication known as delirium, or acute confusion. Patients with delirium may
become frightened and agitated. This in turn leads to other serious problems. Having delirium
doubles the chances of dying or can increase the need for admission into a nursing home.
People with delirium spend an extra week in hospital on average.
Using ultrasound to locate and 'freeze' or block specific nerves can stop hip fracture pain
almost immediately, and use of this technique is known to reduce delirium when administered
by Anaesthetists to patients at the time of their hip operation. Unfortunately, patients with
hip fractures commonly wait hours or even days in the Emergency Department (ED) prior to
their operation. Currently, these patients are given narcotic pain killers like morphine to
dull their pain, as most ED physicians have not been trained in using this 'freezing'
technique and Anaesthetists are rarely able to leave the operating room to administer
freezing to patient in the ED.
The EDU-RAPID study will test whether training ED physicians on how to use the nerve freezing
technique will reduce the number of patients who develop delirium after a hip fracture. To
study this, ED physicians will be trained at 6 hospitals in small groups every 6 weeks over
18 months. The study will look at how patients who are treated by ED physician who has been
trained compare to patients treated by a ED physician who has not yet been trained. Also, the
study will see if the training motivates ED physicians to use the block regularly.
If correct, this study could significantly improve the comfort, quality of life, and
independence of patients who suffer a hip fracture. In addition, if the study shows a
reduction in delirium rates, this could represent a significant cost reduction to the health