Implementation of an ultrasound-guided nerve block program in an academic emergency department

Abstract

Introduction: Ultrasound-guided nerve blocks (UGNBs) offer effective, opioid-sparing analgesia and have been increasingly recognized as a valuable component of multimodal pain management in the Emergency Department (ED). Despite endorsement by major professional societies, adoption of UGNBs among emergency physicians has been slow due to educational, logistical, and interdepartmental barriers. This study describes the implementation of a comprehensive UGNB program at an academic ED using the Practical, Robust Implementation and Sustainability Model (PRISM). Methods: A PRISM-guided implementation framework was applied to the University of Colorado Hospital ED (annual census >115,000). Implementation strategies from 2021 to 2025 included hiring a faculty nerve block champion, building interdepartmental collaboration, establishing EHR templates and order panels, creating dedicated nerve block carts and kits, and developing resident training initiatives. Adoption and reach were measured using RE-AIM metrics from registry and electronic health record data. Results: Zero UGNBs were performed from 2017 to 2020 and only three UGNB were performed in the 6 months prior to program initiation. Following implementation, UGNB procedures increased steadily to over 50 per quarter by mid-2025, encompassing a diverse range of block types. Ninety-three residents and 34 faculty participated in performing or supervising UGNBs. Four ED clinical pathways were updated to include UGNB recommendations, and no patient safety events were reported. Implementation success was facilitated by leadership support, procedural infrastructure, educational programming, and workflow integration. Discussion: Systematic, framework-driven implementation effectively transformed departmental practice, overcoming long-standing barriers to UGNB adoption. Combining structural changes with educational and cultural interventions fostered sustained procedural uptake and interdisciplinary collaboration. The model presented is reproducible for other EDs aiming to enhance multimodal pain management, reduce opioid use, and institutionalize ultrasound-guided procedures.