The Block room of our dreams

Welcome to the nerve block center of the Jessa Hospital! Jessa Hospital is situated in Hasselt, the capital of the beautiful province of Limburg in Belgium. The rural character of the surroundings is reflected in the design of the block room.

Fig 1: The outside entrance to our dreamy nature block room

Patients find themselves in the middle of a nice green meadow. This outdoor mimicking environment not only brings honor to the nearby countryside but also has a calming and relaxing effects on patients of all ages. Scientific research has shown that music and visuals aid in relaxing and might even diminish the amount of sedation needed.(1,2)

It took some persuasion and dedication of the directory board to sway the minds to our vision, however the final result ended in us being extremely proud of our persistence. (Fig 1)

Sealing off a portion of the intake area and adding these nice landscapes made it also feel bigger than it is. In our opinion it also adds to safety. A regional anesthetist needs to be calm and without distraction during a procedure.(3) Time-out faults, drug errors are known to multiply in environments with a high probability of interference and interruption.(4) This space has given us a real oasis of serenity, focus and commitment to deliver the highest quality of regional anesthesia. Explaining procedures, talking trough informed consents and re-informing the patients also improves when it is performed in a low distraction area. (Fig 2)

Fig 2: A robust registration system and fully equipped/monitored room without distraction provides excellent quality.

Dr. Hassanin Jalil MD

With its capacity of 1241 beds, Jessa is one of the largest Belgian hospitals. All services are provided including cardiac surgery and neurosurgery. To provide state-of-the art anesthesia to orthopedic patients, a formal block team was set up after the arrival of Dr. Hassanin Jalil MD (picture left) to Jessa in 2017. Dr Hassanin received his training at UZ Leuven in Belgium and was NYSORA trained in regional blocks.

Peripheral nerve blocks were only occasionally provided to orthopedic patients at that time.  About 300 blocks a year were performed, on random base, however.

The block-room and space creation initiated the successful regional program; however this first step was followed by extensive training own colleagues at the Jessa anesthesia department, a block team of ten consultants was formed.

This allowed an exponential increase in both number and type of blocks. Fascial plane blocks were introduced next to the peripheral nerve blocks. At this point, blocks are not limited to orthopedic patients but are provided for breast surgery, AV fistulae, thoracic surgery, laparotomies and even cardiac and neurosurgery.  Last year, 3563 state-of-the-art nerve blocks were performed at Jessa, a tenfold increase in only four years! The protocolized approach to nerve blocks creates excellent teaching opportunities for residents. The Jessa block team aims to teach every single resident how to safely and accurate apply all basic blocks independently during their trainee rotation. High end equipment, ultrasounds and teaching are all included. (Fig 3)

Fig 3: The inside of our little treasure cave equipped with state-of-the-art ultrasounds

Last year, we developed a formal fellowship in locoregional anesthesia. Our first fellow performed about 600 peripheral nerve and fascial blocks during his first 6 months of fellowship and actively participated in Jessa’s ongoing scientific research. This experience will help him build his own regional anesthesia practice for the future.

The tenfold increase in blocks at Jessa has been a major gamechanger for patients and unit turnover times at Jessa. Future challenges are found in further expansion of the locoregional team, teaching capacity and scientific locoregional work. All serving one goal: Improving patient experience in Jessa hospital.

Fig 4 The Regional team at Jessa https://www.jessazh.be/

References

1. Graff V, Cai L, Badiola I, Elkassabany NM. Music versus midazolam during preoperative nerve block placements: a prospective randomized controlled study. Reg Anesth Pain Med. 2019 Aug;44(8):796–9.
2. Nielsen E, Wåhlin I, Frisman GH. Evaluating Pictures of Nature and Soft Music on Anxiety and Well-Being During Elective Surgery. Open Nurs J. 2018 Apr 24;12(1):58–66.
3. Gui JL, Nemergut EC, Forkin KT. Distraction in the operating room: A narrative review of environmental and self-initiated distractions and their effect on anesthesia providers. J Clin Anesth. 2021 Feb;68:110110.
4. Campbell G, Arfanis K, Smith AF. Distraction and interruption in anaesthetic practice. Br J Anaesth. 2012 Nov;109(5):707–15.