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EP181 Implementation of a chest injury pathway in the emergency department
  1. Claudio Dalla Vecchia1,
  2. Tomas Breslin2,
  3. Cian Mc Dermott2,
  4. Fran O’Keeffe3 and
  5. Ramiah Vinny3
  1. 1Specialist Registrar, Mater Misericordiae University Hospital, Dublin, Ireland
  2. 2Consultant, Mater Misericordiae University Hospital, Dublin, Ireland
  3. 3consultant, Mater Misericordiae University Hospital, dublin, Ireland


Background and Aims Rib fractures represent a substantial health burden. Chest injuries contribute to 25% of deaths after trauma and survivors can experience long standing consequences, such as reduced functional capabilities and loss of work. Over recent years there has been an increase in awareness of the importance of early identification, aggressive pain management and adequate safety-netting for these patients. Poor management leads to increase rates of morbidity and mortality. Aim: Development of an evidence based, multidisciplinary chest injury pathway for the management of patients presenting with rib injuries in the Emergency Department

Methods We used Plan Do study Act cycles as a framework for our quality improvement project. Patients‘ note presenting with torso trauma were reviewed from march to June 2021. Our five Specific, Measurable Actionable Realistic and Timely (SMART) measures were: analgesia on arrival, time to analgesia, fascial block performed, discharge leaflet given and compliance with the pathway.

Results Implementation of the pathway increased rates of documented analgesia received from 39% to 70%. The number of regional blocks performed went from 0% to 60% and the number of patients receiving discharge advice went from 7% to 70%. The use of the pathway by doctor and nurses was 63%.

Conclusions This quality improvement project involved the development of a multidisciplinary pathway for patients presenting to the Emergency Department with rib fractures in order to drive a change from previous practice. The quality of care provided to patients attending with rib fractures showed improvement with increases in analgesia received, blocks performed, and discharge advice given.

  • Torso injury
  • rib injury
  • serratus anterior plane block
  • erector spinae plane block

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