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

Methods

• 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

Results

• Not achieving standard of care at 3 days

• Specialty input:

• 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

• Pain management:

• 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.

Conclusions

• Presented audit at information governance and teaching sessions for medical/surgical and A+E juniors

• Guideline revised with focus on regional anaesthesia

• TIPTOP Implementation:

• 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