Closing the Gap: Standardised Board Rounds Reduce Variation in Chest Trauma Care
Abstract
Introduction
Chest trauma carries significant morbidity, with up to 35% developing complications within 12–48 hours and mortality approaching 20% in frail, high-risk patients. Our hospital manages approximately 350 patients annually, cohorted on a dedicated ward. Initial care is under general surgical/perioperative teams before takeover of care (TOC) by respiratory if appropriate by current SOP. Baseline review demonstrated length of stay (LOS) was below the national average but patients transferred to respiratory experienced disproportionately longer LOS than those managed by perioperative/surgical teams.
Method
Multidisciplinary board rounds (BR) with proactive frailty identification are known to reduce LOS. A standardised thrice weekly multidisciplinary BR was introduced for all chest trauma patients, irrespective of primary team. Led by a consultant perioperative physician with input from respiratory, senior nursing, therapy and pain teams. The BR addressed injury severity, frailty, bone health, analgesia, anticoagulation and any follow-up. LOS before and after implementation was compared.
Results
Preliminary data identified 47 pre-intervention patients (April–May 2026) with a median LOS of 7 days; the 14 TOC-to-respiratory patients had a median LOS of 10 days. Post-implementation, 24 patients have been included to date, with median LOS reduced to 5.5 days. The greatest improvement was seen in the 7 TOC-to-respiratory patients, whose median LOS fell to 7 days (30% reduction). Data collection is ongoing.
Conclusion
A perioperative physician-led multidisciplinary BR for chest trauma patients was associated with an early reduction in LOS, particularly among patients requiring TOC to respiratory medicine, and with reduced variation between care pathways. This may reflect more consistent clinical decision-making, including rationalising investigations to the outpatient setting, accepting minor abnormalities where appropriate, and facilitating direct access to medical clinics to support earlier safe discharge. The BR was well received and promoted consistent decision-making across services. Ongoing data collection will assess whether these improvements are sustained.