537 Optimising Analgesia and Improving Outcomes of Rib Fracture Patients at a Large District General Hospital

Abstract Aim Our aim was to improve outcomes of rib fracture patients at Croydon University Hospital. Method We collected retrospective data on rib fracture patients at Croydon University Hospital. Main factors analysed included pre-admission risk factors, number of rib fractures, presence of rib fracture/pain scoring, analgesia, chest physiotherapy/pain team input, complications, and discharge outcomes. New guidelines were developed and circulated, and the project was presented at the surgical/anaesthetic governance meeting. The second cycle assessed the impact of intervention. Results In cycle 1, 35 patients were reviewed. Analgesia prescribing was inadequate and only 28% of patients received physiotherapy/pain team input. Rib fracture scoring on admission was performed on one patient and no dynamic pain scoring was documented. Following intervention, 10 patients were reviewed. 30% of patients had their STUMBL (STUdy of the Management of BLunt chest wall trauma) score assessed on admission, and 20% had dynamic pain scoring documented. Paracetamol and codeine remained the most prescribed analgesia, with prescribing rates relatively unchanged. Regular morphine prescribing improved significantly (17% to 60%). Physiotherapy and pain team input increased by 21% and 41% respectively. Average number of rib fractures was 1.5x greater and an increase in hospital-acquired pneumonia was noted (17% to 50%). Average length of stay remained 5 days. Conclusions Improvements following intervention include STUMBL scoring, morphine prescribing, and increased physiotherapy and pain team input. However, respiratory complications increased, and length of admission remained unchanged. Further work is needed to improve pain control, including discussions with anaesthetics to increase availability of regional blocks.