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B169 Development of an integrated chest trauma referral pathway and decision making aid
  1. P Leadbeater,
  2. K Emmerson and
  3. T Egan
  1. The Royal London Hospital, Barts Health NHS Trust, London, UK


Background and Aims Patients with rib fractures are at high risk of morbidity and mortality. After initial resuscitation, management is focused on timely administration of multi-modal analgesia and supportive therapies to prevent secondary complications.

We aimed to develop a system that can expedite the identification of patients with rib fractures to the Trauma Anaesthesia Group whilst also prompting referring clinicians to recognise high risk patients and institute locally agreed multi-modal analgesia protocols.

Methods The Trauma Anaesthesia Group, Pain Service and Information Technology department in our hospital collaborated to develop an electronic referral pathway capturing relevant patient data in a system that can feedback patient risk stratification and recommended analgesia.

Results We have developed an electronic tool within the clinical record system that captures patient demographics, vital signs and level of oxygen therapy. Automatic calculation of the chest trauma STUMBL score(1) allows risk stratification, identifying those at high risk of morbidity. In-built prompts guide referring clinicians to discuss high risk patients with Critical Care and recommend optimal multi-modal analgesia so that this can be started from hospital admission. Finally, the referral pathway acts as a portal to the Trauma Anaesthesia Group to enable efficient screening and early intervention with regional anaesthetic techniques, where indicated.

Conclusions Development of an electronic referral pathway will be used for early identification and risk stratification of patients with chest trauma, including evaluation for suitability of regional anaesthetic techniques.

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