Please confirm that an ethics committee approval has been applied for or granted: Not relevant

Background and Aims Blunt thoracic trauma accounts for 10-15% of trauma admissions in the UK, with rib fractures complicating two-thirds of cases. Non-operative management is common in district general hospitals, necessitating a multidisciplinary approach to ensure healing and prevent complications. We aimed to evaluate rib fracture management practices at Lister Hospital and identify areas for improvement.

Methods We retrospectively reviewed electronic records of patients admitted with ‘rib fractures’ over a 5-month period (15/09/2022 – 17/02/2023, Cohort 1). Findings were used to develop a rib fracture pathway, which was implemented and reassessed over a 6-month period (01/09/2023 – 29/02/2024, Cohort 2).

Results Rib fracture admissions occurred every 2-3 days (118 patients), average hospital stay of 12 days. Easter scores increased from 7.8 (1-17) to 11.1 (4-27), indicating increased tendency to non-operative management. Timely referrals to pain teams were made (>80% of cases), but analgesia optimisation was needed in 22-35% of patients. Time to anesthetist review averaged 11.6 hours (range <30 minutes to 48 hours). Use of regional analgesia techniques increased from 30% to 62%, with decrease in epidural rates (45% to 15%), increase in paravertebral (36% to 65%) and erector spinae plane infusions (9% to 19%). Rates of PCA (morphine/fentanyl/oxycodone) were 22%. Critical care admissions decreased from 7% to 4%.

Conclusions Key improvement areas include multidisciplinary teamwork and analgesia management. All patients were reviewed by physiotherapists but a significant proportion were not prescribed appropriate analgesia. The use of regional anaesthetic techniques increased. However, these skills still lie with a relatively restricted group, resulting in long waiting times.