Background and Aims
Evaluate the referral of rib fracture patients to anaesthetics/acute pain team/physiotherapy & Critical Care Outreach Team (CCOT)
Pain management and use of regional techniques for these patients
Offered PCA within first 24 hours
Early physiotherapy – as soon as pain is controlled
Early regional analgesia
CCOT referral if mortality risk is high or NEWS >7
Retrospective audit over the year 2019 at the QEHKL
80 patients coded as having a primary diagnosis of rib fractures – given Pressley Risk & Easter severity score.
29 patients scored moderate/moderate and above, 25 patients’ paper notes were available – first 72 hours of admission was audited
Not achieving standard of care at 3 days
Within 72 hours 80% had anaesthetics + physio reviews
5 patients weren’t reviewed by any external teams
All high risk of mortality patients are not getting a CCOT referral
40% received PCA within 24 hours
At 72 hours 64% of patients had a regional technique/PCA
Regional techniques used were serratus anterior/erector spinae or thoracic epidural catheters. They were left in for an average of 4.4 days.
Presented audit at information governance and teaching sessions for medical/surgical and A+E juniors
Guideline revised with focus on regional anaesthesia
1) Refer high risk thoracic injury patients to anaesthetic/acute pain team.
2) Book patient onto emergency theatre booking system
3) TIPTOP proforma to be completed by acute pain team/anaesthetist to ensure follow up & standardised care
Re–audit in 6 months time
Statistics from Altmetric.com
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