Improving the Pathway for Older Patients with Rib Fractures: A Multidisciplinary Quality Improvement Initiative

Introduction

Rib fractures in older adults are associated with significant morbidity and mortality, mainly due to inadequate pain control and subsequent respiratory complications.

Baseline audit demonstrated fragmented care, with admission across multiple specialties and wards and delayed access to specialist input and analgesia.

Aims

To improve pain management, coordination of care and clinical outcomes for older adults with rib fractures through the implementation of a multidisciplinary care pathway.

Methods

A multidisciplinary pathway was developed involving emergency medicine, radiology, cardiothoracic surgery, anaesthetics and the acute pain service, therapies and geriatric medicine. The pathway supported referral and admission to either cardiothoracic surgery or a dedicated elderly medicine ward for comprehensive multidisciplinary assessment, with staff competent in managing nerve blocks.

Outcomes measures were developed and ongoing audit planned to compare care before and after implementation.

Results

The acute pain service cover increased to 6 days in 2022, improving the day of admission assessment and the use of regional blocks increased from 33% to 43% (2022 to 2024).

Patients admitted to the dedicated elderly ward increased from 35% to 59% in a three-month audit comparing 2023 to 2024. However, rates of osteoporosis assessment and secondary fracture prevention remained low. No patients had a FRAX assessment documented and only 20% of patient had bone protection initiated (12/62).

Additional outcome measures, including length of stay and complications were not collated locally but are being evaluated through national audits and planned reviews.

Conclusions

A multidisciplinary approach to rib fracture management in older adults can improve pain control and coordination of care. Early outcome data suggests benefits in service delivery, although further structured multidisciplinary audit is required to confirm effects on complications and hospitalisation.

Integration of bone health assessment and secondary fracture prevention is a priority for future pathway development.