#127 From the outside in: developing a standardized rib fracture pathway for a trauma unit with special services

<h3>Introduction</h3> It is now well established that rib fractures are associated with significant morbidity and mortality in blunt chest trauma patients, particularly those over 65 years. Complications often arise due to lack of recognition, inadequate analgesia and inadequate ventilation. In this ED, blunt chest trauma is common, but it was noted that on admission, not all patients got the same standard of care. This prompted a QIP aimed at standardizing the diagnosis, management and disposition of patients with rib fractures in this hospital, with care starting at the front door when they arrive to the ED. <h3>Methods</h3> A working group was established consisting of Emergency Medicine, ICU, Physiotherapy, Radiology, Cardiothoracic Surgery and Pain Management. A rib fracture proforma was developed and key performance indicators (KPIs) agreed upon. Education sessions were held to introduce the PIC and STUMBL scores, incentive spirometry and appropriate analgesic recommendations including chest wall regional anaesthesia. PDSA cycles commencement and review dates were agreed upon and the pathway was launched. <h3>Results</h3> PDSA 1 identified 8 patients with rib fractures and there were improvements noted in the majority of the KPIs. Further education was delivered to NCHDs in ED, and 1 month later, PDSA 2 (6 patients) showed continuous improvements in all KPIs with ongoing review by the implementation team needed to sustain the desired change. <h3>Conclusion</h3> Trauma is a team game, and this QI demonstrates the benefit of multi-disciplinary teamwork to develop a solution to a common patient-centred problem. The work is ongoing, but early findings suggest the standard of care is significantly improving. Correlation with metrics such as patient experience time, length of stay and complication rates would be useful to fully assess the benefit of the pathway.