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PUTTING THE EMPHASIS ON RIB FRACTURES: RECOGNISING THE NEED FOR A MULTIDISCIPLINARY PATHWAY IN MANAGING A HIGH RISK PATIENT POPULATION
ESRA Academy. Desai M. Sep 8, 2016; 138379
Topic: Analgesia for Rib Fractures

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Abstract
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Background and Aims:

Multiple ribs fractures are associated with high morbidity and mortality particular in elderly patients.  For these patients - studies have shown the benefits of multidisciplinary clinical pathways [1] and analgesia options including: intercostal blocks, thoracic epidural and paravertebral blocks (PVBs) [2]. We audited how well our rib fracture patient population was managed in order to identify how we could improve this service. 

Methods:

Data was collected of all patients referred to the pain team over a 4 month period. Referrals came from all members of the multidisciplinary team mainly in response to increasing analgesia requirements

Results:

33 patients were discharged over this period with multiple rib fractures of which 19 were referred to pain services – with an average age of 71 years old and length of stay of 12 days.

There were 3 cases of delayed referral >5 days from admission of which 2 died in hospital.

A wide variety of referral routes was observed and importantly 5 patients with multiple rib fractures were managed with oral analgesia alone. In these cases 2 developed respiratory failure and died during their admission (aged 94 and 79).Conclusions:

In response to wide variation and delays in referral practice in a high risk population - we developed a multidisciplinary rib fracture pathway focussing on:

- Early referral to pain team and where appropriate encouraging the use of regional anaesthesia.

- Improving education in A&E and surgical wards.

- Delivering training to anaesthetic colleagues on paravertebral blocks.

- 4 monthly audit of performance

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