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B186 Evaluating the timings of regional anaesthesia for rib fractures to inform service improvement within an established chest trauma pathway
  1. B Dingle,
  2. R Webb,
  3. G Simpson and
  4. W Spencer
  1. Royal Devon and Exeter NHS Trust, Exeter, UK


Background and Aims We have established a multi-disciplinary chest trauma pathway within our hospital which includes guidelines for regional anaesthesia. This service is currently supported by the on-call anaesthetic team, resulting in an increased emergency theatre workload. We sought to evaluate timings of admission, referral, review, and placement of regional anaesthesia to inform service improvement.

Methods 38 patients with “rib fractures” or “chest injury” were identified via the TARN (trauma audit and research network) database over a 3 month period (Oct- Dec 2021). Exclusions included age <18, isolated sternal fracture, and direct transfer to the major trauma centre (MTC).

Results Patients had an average age of 74, Rockwood frailty score of 3.6. 40% of cases presented on weekends or bank holidays, 34% out of hours (17:00–08:00 Monday-Friday) with only 26% presenting during normal working hours (Monday-Friday 08:00–17:00). The mean time from referral to review was 5 hours 26 minutes (range 22 minutes to 21.5 hours) with an average time to block placement an additional 5 hours 40 minutes (range 33 minutes to 22 hours). Most blocks were performed out of hours (33% weekday night, 17% weekend day, and 28% weekend night), with only 22% during weekday daylight hours.

Conclusions The majority of referrals and blocks are performed out of hours which can introduce significant delays. We aim to implement a dedicated block service for catheter insertion during daylight hours, and provision of single-shot blocks out of hours with a view to improving early access to regional anaesthesia for chest trauma.

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