DOI: 10.1177/03000605261471253 ISSN: 0300-0605

Evaluation of a rib fracture management pathway in an Australian tertiary trauma hospital

Craig Morrison, Kiara Song, Tim Soon Cheok, Sean Liew, Rohen Skiba, Greg Rice, Ruurd L Jaarsma, Hidde M Kroon, D-Yin Lin

Objective

Rib fractures are a common cause of hospitalisation in the adult trauma population and are associated with significant morbidity and mortality. This study aimed to assess the efficacy of a bundle of care known as the ‘rib fracture pathway’ in improving patient-centred outcomes and health economic outcomes in an Australian tertiary trauma hospital.

Methods

This single-centre retrospective cohort study analysed prospectively collected pain registry data from 2004 to 2022, encompassing the period before and after the implementation of the rib fracture pathway.

Results

The implementation of a rib fracture pathway was not associated with a reduction in patient reported pain scores at rest or on movement. Post-implementation, patients were more likely to receive a regional nerve block (56.7% vs. 10.4%, p  < 0.001). Despite this, length of hospital stay was increased post-implementation (8.9 vs. 8.1 days, p = 0.01), and duration of Acute Pain Service follow-up increased (3.8 vs. 3.0 days, p  < 0.001). The lengthier hospital stay persisted in patients with >2 rib fractures (8 vs. 7 days, p  = 0.01).

Conclusions

This study demonstrates that the implementation of a rib fracture pathway was not associated with clear improvements in patient-centred outcomes and was associated with adverse health economic outcomes, including increased length of hospital stay.

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