Expert Behaviors USGRA

Expert Behaviors in Ultrasound Guided Regional Anesthesia A Mixed-Methods Study

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.

Study Overview

• Status: Unknown
• Conditions: Anesthesia Education

• Study Type: Observational
• Enrollment (Anticipated): 190

Contacts and Locations

• Study Contact: Name: Rongyu (Cindy) Jin; Phone Number: 2016 416-603-5800; Email: rongyu.jin@uhn.ca

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• 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.

Description

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

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Qualitative behaviors of experts performing UGRA techniques during pre-procedural discussion	Reviewers will identify behaviors exhibited by the expert operators during pre-procedural discussion	1 hour before procedure
Qualitative behaviors of experts performing UGRA techniques during patient and equipment preparation	Reviewers will identify behaviors exhibited by the expert operators during patient and equipment preparation	0.5 hour before procedure
Qualitative behaviours of experts performing UGRA techniques during ultrasound scanning of the target area;	Reviewers will identify behaviors exhibited by the expert operators during ultrasound scanning of the target area;	10 minutes before procedure
Qualitative behaviours of experts performing UGRA techniques during needle advancement and local anesthetic deposition around the target nerve(s)	Reviewers will identify behaviors exhibited by the expert operators during needle advancement and local anesthetic deposition around the target nerve(s).	during procedure
Quantitative data on block effectiveness defined by blocks requiring top-up	number of top-up will be collected	0-1 hour after procedure
Quantitative data on block effectiveness defined by blocks requiring conversion to GA	Incidence will be documented in case conversion to GA is needed	0-1 hour after procedure
Quantitative data on time to surgical anesthesia	defined by final needle removal to surgical anesthesia	0-1 hour after procedure
Quantitative data on time to block completion	defined by needle insertion to final needle removal	0-1 hour after procedure

Collaborators and Investigators

• Sponsor: University Health Network, Toronto
• Investigators: Principal Investigator: Ki Jinn Chin, MD, University Health Network, Toronto

Study record dates

Study Major Dates

• Study Start (Anticipated): August 15, 2020
• Primary Completion (Anticipated): July 15, 2021
• Study Completion (Anticipated): August 15, 2021

Study Registration Dates

• First Submitted: June 30, 2020
• First Submitted That Met QC Criteria: June 30, 2020
• First Posted (Actual): July 2, 2020

Study Record Updates

• Last Update Posted (Actual): July 31, 2020
• Last Update Submitted That Met QC Criteria: July 29, 2020
• Last Verified: June 1, 2020

More Information

Terms related to this study

• Other Study ID Numbers: 19-6238

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No