Summary
Development of Co-produced guidance for the care of Patients with blunt Chest wall Trauma: a mixed methods study
Funder: HCRW
Many patients go to A&E for help when they have hurt their ribs. A large proportion of these patients are elderly, frail people who have fallen. Four times more people fall and hurt their ribs, than those who break their hip, but much less is known about the people who hurt their ribs and how best to manage them. If they are sent directly home from A&E, the patient is expected to manage their injury on their own, and this can often mean that the patient needs to go back to A&E or to the GP. If they do get a chest infection or pneumonia, this can lead to a long hospital stay, or can even be fatal. There are currently no standard guidelines that can be used to help care for the patients who are discharged home from A&E.
We aim to develop guidelines that can be used to improve the care of patients with rib injuries, who are not admitted to hospital. We will do this by working with these patients and with the clinicians who manage the patients in A&E.
What we want to understand
1) How clinicians in the UK currently manage the patients who are directly discharged from A&E 2) The similarities and differences between the people who have injured their ribs and been managed at home in the past. We want to know:
a) their age, how severe their injury was, did they have a lung disease before they hurt their ribs, what medication they normally take.
b) what painkillers they were given by A&E and whether the painkillers helped, what advice (If any written or verbal) they were given in A&E.
c) whether they developed a chest infection or their pain was unmanageable, whether they went to their GP or back to A&E, what tablets they were given when they went back, whether they needed to be admitted to hospital and if so, how long they stayed in hospital
How we will do this
1) We will send a survey to A&E clinicians working in the UK to see how they currently manage this group of patients.
2) We will use NHS information from across Wales to find out information about these patients. Detailed information that could identify the patient will be removed (such as names and addresses).
3) We will talk to people who have hurt their ribs in the past and A&E clinicians who manage these patients. We will use Swansea Bay University Health Board to do this. We will also tell patients why we are asking them to be involved in the study and make sure they understand that they can withdraw consent at any time.
We have two people who have hurt their ribs in the past, who have been part of our research team for the last five years. They will be involved in managing this study. They will help us by giving their opinions on the study as it progresses, sharing in any decision-making by the research team, and be involved in the co-production workshops that will help put together the guidance.
Informing people about our study results
We will publish our results in journals that are read by the clinicians who manage patients with rib injuries. We will present our results in conferences and also share our findings in meetings with people who organise and manage health services. We will meet with people who have hurt their ribs and with people who work in A&E to talk about what we find out and to publicise the co-produced guidance. We may also be able to discuss the guidance with General Practitioners and the Welsh Ambulance Service Trust, as both GPs and paramedics are often also assessing these patients.