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40 Development of a regional anaesthesia service for rib fractures: a quality improvement project
  1. A Ee and
  2. T Rees
  1. Royal Gwent Hospital, Newport, UK


Background and Aims Trauma audit research network (TARN) data for 2018 indicated that 100 patients are admitted with chest wall injuries. Retrospective audit of referrals confirmed long length of stay (median 14 days), with 59% requiring level 2/3 care and 11% mortality risk.

Regional anaesthesia was offered to less than 25% of patients despite 63% reporting severe pain. We decided to introduce an Erector Spinae plane (ESP) catheter service for these patients with aims of reducing length of stay and pain scores.

Methods We set up an email alert system, where TARN data collectors notified us when patients were admitted through the Emergency department with rib fractures. Using Whatsapp, we organised a group of regional anaesthetists who were willing to provide an ESP service.

Results Mean length of hospital stay was reduced from 10 to 7 days after introduction of the service with significant reduction in variability.

Mean pain scores improved from 8.9/10 to 5/10 with an average improvement of pain score of 2.78 points on a numerical scale out of 10. (n=9)

Conclusions This was an easy, cost-neutral intervention that has made a noticeable difference in a short time frame. The small reduction in pain scores may be explained by the presence of concurrent injuries. Ongoing improvements in training should improve reliability of catheter placement and reduce practitioner variation.

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