{
  "abstract": "Background and Aims Background A previous audit showed inconsistent care and suboptimal outcomes in patients with rib fractures. A new trauma pathway was introduced at our hospital in response. Key features included consistent use of ESP blocks and automatic referrals to the pain team, physiotherapy, and critical care. Aims To evaluate the impact of the new pathway on clinical management and patient outcomes.Methods Data was collected retrospectively via TARN for all adult patients presenting with traumatic rib fractures between January and June 2024. Patients with atraumatic or iatrogenic fractures were excluded. A total of 53 cases were included. Variables reviewed included age, RFS and PIC scoring rates, analgesia type (PCA, ESP block), time to intervention, length of stay, and mortality. These were compared with figures from a previous audit cohort (n=48, 2023). Regional block rates were based on documented catheter insertions.Results Of the 53 patients in the 2024 cohort, 28 were eligible for advanced analgesia. Twelve received patient-controlled analgesia (PCA), similar to the 2023 audit (42.8% vs 42.5%). Sixteen patients (30%) received ESP catheters, representing an increase in regional anaesthesia provision (57.1% of eligible patients vs 30.7%). Rib Fracture Scores (RFS) were documented in 84.9% of cases, compared to 25% in 2023. The PIC score was introduced as part of the new pathway. Referrals were more consistent and appeared to occur earlier. Mortality fell slightly (6 vs 4 patients), and length of stay ≥14 days reduced (13 to 9). ITU admissions rose (5 to 7). Out-of-hours regional anaesthesia provision remained variable due to limited availability of anaesthetists with ESP block skills.Conclusions The revised pathway improved early multidisciplinary input and increased use of regional anaesthesia. Documentation and standardisation of care improved. Increased teaching improved Out-of-hours anaesthetic support with improvements in patient outcomes. However there is room for ongoing improvements and further investment is required.",
  "authors": [
    {
      "affiliations": [
        "Anaesthetics, Countess of Chester NHS Foundation Trust, Warrington, UK"
      ],
      "name": "Varun Chuahan"
    },
    {
      "affiliations": [
        "Anaesthetics, Countess of Chester NHS Foundation Trust, Chester , UK"
      ],
      "name": "Woei LIn Yap"
    }
  ],
  "title": "P239 An audit of rib fracture management following the introduction of a multidisciplinary trauma pathway at a district general hospital",
  "uid": "ad56209b-a626-5961-980b-ee689756b9a5"
}