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84 Thoracic injury pathway to optimise pain & physiotherapy
  1. S Mohamedally and
  2. B Fox
  1. Queen Elizabeth Hospital Kings Lynn, King’s Lynn, UK


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

  • 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.


  • 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

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