84 Thoracic injury pathway to optimise pain & physiotherapy

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