Improving time to block in neck of femur fractures in a metropolitan Emergency Department

Ms Jo-anne Mcshane1

1Eastern Health, Box Hill South, Australia

Potential neck of femur fractures (#NOF) is a common Emergency Department presentation in the elderly population. It was found during an audit of #NOF’s that the time to block could be improved with initial results showing that the median time to nerve block was 177min.

Aim: Improving time to nerve block for potential neck of femur fractures.

Methodology: The project was retrospective pre/post interventional study looking at making simple system changes within the ED to improve time to nerve block and reduce the use of opioid analgesia in this patient population. The study included a retrospective audit of potential #NOFs for the 3mth period prior to the intervention and a 3mth post intervention period. The intervention included an upscale from the traditional triage category of this site from 3 to 2 and a change of streams from low-acuity to high-acuity. In addition, an educational campaign was launched and ‘block packs’ were made for convenience of use.

Results: After meeting the inclusion criteria, a total of 156 nerve blocks were given during the study period for a suspected #NOF at triage. It was found there was a decrease in time to block from 138min (median 126 min) to 72min (median 53min). Patients receiving a nerve block prior to Xray from increased from 47% to 68%. There was no significant change to time to treatment or length of stay. Neurovascular observations in this patient population was poor warranting further study, a review of departmental policy and education in this area.

Conclusion: There was a significant improvement in time to nerve block for patients with a suspected #NOF in the intervention period with a corresponding decrease in pain levels and use of opioid analgesia. Patients were also more likely to receive a nerve block prior to Xray in the intervention period.


With over 20yrs experience, Jo-Anne is a emergency research nurse at Box Hill Emergency Department in Victorian.