Regional analgesia for hip fractures in emergency departments in Johannesburg, South Africa: a prospective cross-sectional survey assessing doctors’ knowledge, attitudes and practices
Robert Klaus Uhrich, Craig Beringer, Louis ChadinhaObjective
This study aimed to describe the knowledge, attitudes and practices of emergency department (ED) doctors regarding regional analgesia (RA) for hip fractures and to compare these across levels of experience.
Design
A prospective, multicentre survey-based cross-sectional study.
Setting
Surveys were collected at the EDs of three university-affiliated hospitals in Johannesburg, South Africa.
Participants
80 surveys were collected. Participants included all ED doctors. Doctors completing their internship years were excluded.
Primary and secondary outcomes
The primary objectives of this study were to describe the knowledge, attitudes and practices of participants regarding the use of RA in hip fractures in the ED; to compare these across different levels of experience based on age, rank and number of years working in the ED; to describe perceived barriers to its use and to describe the frequency of RA use for hip fracture among participants.
Results
Thirty-nine per cent of respondents reported having received hip fracture-specific RA training, of whom 52% felt adequately prepared. Knowledge scores (median, IQR) were low for single best answer questions (50%, 39–67) and complications (50%, 38–75), but higher for contraindications (83%, 67–100) and indications (75%, 50–100). Attitudes were broadly positive: 93% viewed RA as safe and effective, and 88% felt all ED doctors should be proficient. Training was mostly informal (94%), predominantly via bedside teaching from an emergency medicine colleague (65%). RA for hip fractures was underused, with 39% reporting never performing it and 27% reporting seldom use. The most cited barrier was a lack of skills (49%), which decreased with increasing ED experience (p=0.012).
Conclusion
Despite self-reported generally strong positive attitudes towards RA for hip fractures, it remains underused. Insufficient skills and training were the most common self-reported barriers. Future research could be aimed at assessing the impact of standardised training and departmental protocols on clinical practice.