What question did this study set out to answer?

The aim is to improve early injury recognition, frailty identification, optimal pain management, and reduce morbidity and mortality for older patients with chest wall trauma.

February 8, 2026

3677 Implementation and development of a chest wall trauma pathway to improve patient safety

Key Points

The aim is to improve early injury recognition, frailty identification, optimal pain management, and reduce morbidity and mortality for older patients with chest wall trauma.
Developed a Chest Wall Trauma pathway through 3 PDSA (Plan-Do-Study-Act) cycles using quality improvement methodology.
Collected retrospective data from coded and bulk admission records.
Iteratively refined the pathway based on insights from earlier cycles, focusing on recognition, pain management, shared care, and escalation planning.
Early trauma CT scans were provided to 94-96% of patients.
Paracetamol and opiates were prescribed to 100% of cases, but NSAID prescribing remained low at 24.5%.
Collaborative care improved significantly, with over 94% of admissions under the appropriate specialty, compared to 58% initially.
Escalation planning was noted as reactive, with only 45% having documented status during hospital stay.

Abstract

Abstract Background A Quality Improvement Project (QIP) at University Hospitals Dorset involving multiple specialties (Older People’s Services, General Surgery, Pain Team, Anaesthetics, Emergency Department, Radiology, Pharmacy) focused on improving care for adult patients with Chest Wall Trauma. Incidence and severity increase significantly with age (recent audits found a 12% mortality), with complications that can be life-threatening. Key to good management is early injury recognition, effective pain control, frailty assessment, and timely escalation planning. Introduction A series of deaths following falls in older patients revealed delayed or missed diagnoses of traumatic haemothorax. In 56% of cases, significant chest trauma went unrecognised. A Chest Wall Trauma (CWT) pathway was introduced. A notable issue was reluctance among resident doctors to prescribe NSAIDs in older patients, with only 24.5% receiving appropriate NSAID therapy. Our aims Earlier recognition, frailty identification, optimal analgesia, and reduced morbidity/mortality. Methods The CWT pathway was developed through 3 PDSA cycles, using QI methodology. Retrospective data was collected via coded and bulk admission data. Initial cycles revealed under-recognition of injury, suboptimal analgesia, weak shared care between surgery and OPS, and limited escalation planning. These insights informed pathway iterations, now in its 4th version. Results Prompt injury recognition improved, with 94–96% of patients receiving early trauma CT scans. Paracetamol and opiates were prescribed in 100% of cases. NSAIDs remained underutilised in older adults (24.5% prescribed). Collaborative care improved markedly, with 94% of patients admitted under the most appropriate specialty (up from 58%). Escalation planning has been found to be reactive, with only 45% of patients having a documented escalation status during admission. Conclusions Timely injury recognition and appropriate ward admission have improved significantly. The 4th pathway iteration includes clearer NSAID guidance for older patients, structured escalation prompts, and digital integration within the Electronic Patient Record (EPR) improving availability of the pathway. Research Ethics approval not obtained as Clinical Audit Facilitator did not feel it was necessary.

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Cite This Study

Vanco et al. (Sun,) studied this question.

synapsesocial.com/papers/698828330fc35cd7a884781f https://doi.org/https://doi.org/10.1093/ageing/afaf368.082

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