Clinical trial NCT04454801: Expert Behaviors USGRA
Official title: Expert Behaviors in Ultrasound Guided Regional Anesthesia A Mixed-Methods Study
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Anesthesia Education
Lead sponsor: University Health Network, Toronto
Sponsor class: OTHER
First posted: 2020-07-02
Enrollment: 190
Sex: ALL
Minimum age (years): 18
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: This is a mixed methods assessment study to be completed at TWH. We will recruit 10 fellowship-trained regional anesthesiology and pain medicine staff anesthesiologists to perform USGRA blocks while being video-recorded. Here, we specifically define expert as a staff anesthesiologist who has completed a fellowship in regional anesthesia and/or chronic pain and has at least 6-years of post-fellowship clinical experience with USGRA.

Consent will also be sought from 180 patients undergoing USGRA for surgical procedures at TWH to have the block completed by an expert, as previously defined, and to have the procedure recorded.

Brief summary: Expert-performance begins by focusing specifically on the end-product of training and experience in the hands of the expert. By defining expert behaviors and techniques, investigators can guide learners and non-expert practitioners by offering them models to emulate. At Toronto Western Hospital (TWH), there are more than ten expert attending regional anesthesiologists who routinely provide clinical patient care in the block room. The primary objective of this study is to qualitatively and quantitatively examine behavior of experts performing ultrasound guided regional anesthesia techniques to identify those which are consistent and unique, and which may underpin expert performance.


Eligibility criteria: Inclusion Criteria:

* All elective patients coming to the regional BR at TWH aged 18-80

Exclusion Criteria:

* Any contraindication to USGRA (LA allergy, patient refusal, infection at injection site, etc.)
* Inability to read or speak or comprehend English fluently

Primary outcomes:
measure: Qualitative behaviors of experts performing UGRA techniques during pre-procedural discussion
timeFrame: 1 hour before procedure
measure: Qualitative behaviors of experts performing UGRA techniques during patient and equipment preparation
timeFrame: 0.5 hour before procedure
measure: Qualitative behaviours of experts performing UGRA techniques during ultrasound scanning of the target area;
timeFrame: 10 minutes before procedure
measure: Qualitative behaviours of experts performing UGRA techniques during needle advancement and local anesthetic deposition around the target nerve(s)
timeFrame: during procedure
measure: Quantitative data on block effectiveness defined by blocks requiring top-up
timeFrame: 0-1 hour after procedure
measure: Quantitative data on block effectiveness defined by blocks requiring conversion to GA
timeFrame: 0-1 hour after procedure
measure: Quantitative data on time to surgical anesthesia
timeFrame: 0-1 hour after procedure
measure: Quantitative data on time to block completion
timeFrame: 0-1 hour after procedure
Secondary outcomes:
Other outcomes:
Locations:
Study officials:
affiliation: University Health Network, Toronto
name: Ki Jinn Chin, MD
role: PRINCIPAL_INVESTIGATOR
References: