PT - JOURNAL ARTICLE AU - Mohamedally, S AU - Fox, B TI - 84 Thoracic injury pathway to optimise pain & physiotherapy AID - 10.1136/rapm-2021-ESRA.84 DP - 2021 Sep 01 TA - Regional Anesthesia & Pain Medicine PG - A43--A44 VI - 70 IP - Suppl 1 4099 - http://rapm.bmj.com/content/70/Suppl_1/A43.2.short 4100 - http://rapm.bmj.com/content/70/Suppl_1/A43.2.full SO - Reg Anesth Pain Med2021 Sep 01; 70 AB - Background and AimsEvaluate 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 patientsOffered PCA within first 24 hoursEarly physiotherapy – as soon as pain is controlledEarly regional analgesiaCCOT referral if mortality risk is high or NEWS >7MethodsRetrospective audit over the year 2019 at the QEHKL80 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 auditedResultsNot achieving standard of care at 3 daysSpecialty input:Within 72 hours 80% had anaesthetics + physio reviews5 patients weren’t reviewed by any external teamsAll high risk of mortality patients are not getting a CCOT referralPain management:40% received PCA within 24 hoursAt 72 hours 64% of patients had a regional technique/PCARegional techniques used were serratus anterior/erector spinae or thoracic epidural catheters. They were left in for an average of 4.4 days.ConclusionsPresented audit at information governance and teaching sessions for medical/surgical and A+E juniorsGuideline revised with focus on regional anaesthesiaTIPTOP Implementation:1) Refer high risk thoracic injury patients to anaesthetic/acute pain team.2) Book patient onto emergency theatre booking system3) TIPTOP proforma to be completed by acute pain team/anaesthetist to ensure follow up & standardised careRe–audit in 6 months time