Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Implementation science for the adductor canal block: A new and adaptable methodology process
Nikhil Crain, Chun-Yuan Qiu, Stephen Moy, Shawn Thomas, Vu Thuy Nguyen, Mijin Lee-Brown, Diana Laplace, Jennifer Naughton, John Morkos, Vimal Desai
Nikhil Crain, Bowman Gray Center for Medical Education, Wake Forest School of Medicine, Winston-Salem, NC 27103, United States
Chun-Yuan Qiu, Perioperative Service and Anesthesiology, Kaiser Permanente Medical Center, Baldwin Park, CA 91706, United States
Stephen Moy, Shawn Thomas, Vu Thuy Nguyen, Mijin Lee-Brown, Diana Laplace, Jennifer Naughton, Vimal Desai, Department of Anesthesiology, Baldwin Park Medical Center, Southern California Kaiser Permanente Medical Group, Baldwin Park, CA 91706, United States
John Morkos, Johns Hopkins University, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
Author contributions: Crain N and Desai V contributed equally to the work; Qiu C, Moy S, Thomas S, Nguyen VT, Lee-Brown M, and Laplace D contributed to study conception and research design; Naughton J contributed to study design and data collection; Crain N performed statistical analysis; Crain N, Qiu C, Morkos J, and Desai V drafted the article; Moy S, Thomas S, Nguyen VT, Lee-Brown M, Morkos J, and Desai V made critical revisions; all authors have read and approved the final manuscript.
Conflict-of-interest statement: Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/Licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist. See attached document.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Vimal Desai, MD, Doctor, Department of Anesthesiology, Baldwin Park Medical Center, Southern California Kaiser Permanente Medical Group, 1011 Baldwin Park Blvd, Baldwin Park, CA 91706, United States. vimal.desai@kp.org
Received: April 1, 2021
Peer-review started: April 1, 2021
First decision: June 7, 2021
Revised: June 18, 2021
Accepted: September 27, 2021
Article in press: September 27, 2021
Published online: November 18, 2021
ARTICLE HIGHLIGHTS
Research background
In 2016, we employed Perioperative Surgical Home (PSH) practice change for ambulatory total knee arthroplasty (TKA) resulting in reduced length of stay in our system. Nevertheless, we acknowledged the need for continuous improvement and implementation of new practices to optimize short-term outcomes in our TKA patient population.
Research motivation
We employed a new look at implementation science to remove outdated PSH elements and adopt modified consolidated framework for implementation research (mCFIR) practices. Our motivation was to investigate the transition from femoral nerve blocks (FNB) to adductor canal nerve blocks (ACB) and how learnings on change management could be applied to other surgical areas.
Research objectives
To execute our institution’s implementation process during the phase-out of FNB and phase-in of ACB during TKA. While the rationale for ACB practice was not novel, we focused on identifying the enablers of success practice change.
Research methods
We tracked our institution’s implementation progress through utilization rates by neuraxial anesthesia type. Goals of enhancing patient care were validated through the comparison of perioperative outcomes between FNB and ACB patients.
Research results
Application of the mCFIR was shown to be successful in implementing institutional practice change for ACB during TKA within 6 mo. Increased patient mobility and improved physical therapy outcomes were demonstrated in ACB vs FNB patients.
Research conclusions
Our institution’s successful phase-out of FNB and phase-in of ACB within 6 mo demonstrates the valuable role of implementation science. Effective physician education with technical support and metrics evaluation are critical methods to achieve swift practice change.
Research perspectives
Future research should be focused on younger patient populations and different orthopedic procedures.
