184 Closed-Loop Audit on Upper Limb Bite Injuries at a Major Trauma Centre

Aim To assess compliance of management of upper limb bite injuries with Departmental guidelines, generate an action plan to address areas requiring improvement, and close the loop to review outcomes. Method A total of 38 patients in April 2023 and 27 patients in October 2023 presented to University Hospital Coventry. Trust electronic software was used to identify patients and collect data that reflected the standards set by the Departmental guideline, including treatment given at first presentation and subsequent management. Results The Departmental guideline was updated in accordance with The British Society for Surgery of the Hand. This resulted in an improved 86% of all patients, including 100% with infection, who required an operation to be completed within 24 hours. First contact practitioners provided a thorough washout in 25% of patients in the Emergency Department. An overall 30% required a formal washout in theatre by a surgeon, of which 25% required a second operation. Further, all but one patient initially discharged from the Emergency Department to Hand Trauma Clinic were managed conservatively, and 23% required more than one follow-up appointment. Additional recommendations focused on enabling better care by first contact practitioners, including clinical training for simple wound excision and washout in ED and encouraging improved documentation, as well as providing a dedicated minor ops room with accessible equipment. Conclusions A closed-loop audit on the management of upper limb bite injuries showed a marked improvement in achieving compliance with a revised Departmental guideline, with further recommendations targeted at enabling first contact practitioners.