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Abstract
Background and Aims In high risk patients, pain arising from rib fractures can lead to pulmonary complications with associated morbidity, mortality and cost implications. Optimising pain relief is vital and regional analgesia (RA) is viewed as the gold standard. In a major trauma centre, referrals for analgesia in patients with chest wall trauma continue to rise (figure 1), and where regional analgesia has traditionally been limited to the operating theatre complex, delays in performing RA for this at-risk group impact patient outcomes.
Methods A multidisciplinary working party scoped opportunities for performance of RA for rib fractures in the emergency department (ED). Detailed stakeholder analysis identified numerous barriers to be overcome.
Results Barriers included: • Capacity required to train ED staff on catheter placement and management • Governance of non-anaesthetic staff performing catheter techniques • Concerns of potential drug errors with in situ catheters • Specialty prioritisation of patients with rib fractures • Reduced availability of anaesthesia providers during out of hour periods. An infographic of the resultant guideline highlights how key barriers were addressed by the working group (figure 2).
Conclusions Effective interdepartmental working can lead to service innovation and improvement. Minimising delays in performing RA will positively impact patients admitted to our centre with major chest trauma, and helps to embed RA within service provision.
Number of blunt chest trauma analgesia referrals per annum in a major trauma centre in the United Kingdom
Infographic adopted into practice by a major trauma centra as a standard operating procedure for performing ESP catheters within the emergency department